Language disorders: a functional approach to assessment and intervention [5th ed] 9780205607648, 0205607640, 3509420106189

The new fifth edition of Language Disorders offers a comprehensive discussion of language disorders and clinical practic

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Language disorders: a functional approach to assessment and intervention [5th ed]
 9780205607648, 0205607640, 3509420106189

Table of contents :
Cover......Page 1
Contents......Page 4
Preface......Page 10
Part 1 Introduction......Page 12
1 A Functional Language Approach......Page 14
Role of Pragmatics in Intervention......Page 19
Role of Generalization in Intervention......Page 21
Evidence-Based Practice......Page 28
Conclusion......Page 30
2 Language Impairments......Page 32
Diagnostic Categories......Page 33
Conclusion......Page 74
Part 2 Communication Assessment......Page 78
3 Assessment of Preschool and School-Age Children with Language Impairment......Page 80
Psychometric Versus Descriptive Procedures......Page 82
Psychometric Assessment Protocols......Page 84
Descriptive Approaches......Page 91
An Integrated Functional Assessment Strategy......Page 94
Conclusion......Page 109
4 Assessment of Preschool and School-Age Children with Language Difference......Page 110
State of Service Delivery......Page 112
Overcoming Bias in an Assessment......Page 118
An Integrated Model for Assessment......Page 122
Conclusion......Page 131
5 Language Sampling......Page 132
Planning and Collecting a Representative Sample......Page 133
Recording the Sample......Page 149
Transcribing the Sample......Page 151
Conclusion......Page 154
6 Analysis Across Utterances and Partners and by Communication Event......Page 156
Across Utterances and Partners......Page 158
Communication Event......Page 164
Conversational Partner......Page 184
Conclusion......Page 186
7 Analyzing a Language Sample at the Utterance Level......Page 187
Language Use......Page 188
Content......Page 195
Form......Page 203
Conclusion......Page 226
8 Narrative Analysis......Page 227
Collecting Narratives......Page 229
Narrative Analysis......Page 231
Children with CLD Backgrounds......Page 244
Narrative Collection and Analysis......Page 246
Conclusion......Page 247
Part 3 Intervention......Page 250
9 A Functional Intervention Model......Page 252
Principles......Page 254
Generalization Variables......Page 259
Conclusion......Page 276
10 Manipulating Context......Page 277
Nonlinguistic Contexts......Page 278
Linguistic Contexts......Page 280
Top-Down Teaching......Page 290
Conclusion......Page 292
11 Specific Intervention Techniques......Page 293
Pragmatics......Page 294
Semantics......Page 310
Syntax and Morphology......Page 333
Children with CLD Backgrounds......Page 344
Use of Microcomputers......Page 347
Conclusion......Page 349
12 Classroom Functional Intervention......Page 350
Background and Rationale: Recent Educational Changes......Page 351
Role of the Speech-Language Pathologist......Page 355
Elements of a Classroom Model......Page 357
Instituting a Classroom Model......Page 381
Conclusion......Page 385
13 Literacy Impairments: Language in a Visual Mode......Page 386
Reading......Page 388
Writing......Page 408
Conclusion......Page 419
A: Considerations for CLD Children......Page 420
B: Language Analysis Methods......Page 430
C: Selected English Morphological Prefixes and Suffixes......Page 454
D: Indirect Elicitation Techniques......Page 456
E: Intervention Activities and Language Targets......Page 460
F: Use of Children's Literature in Preschool Classrooms......Page 464
D......Page 478
L......Page 479
S......Page 480
W......Page 481
References......Page 482
B......Page 546
C......Page 547
D......Page 548
F......Page 549
H......Page 550
K......Page 551
L......Page 552
M......Page 553
P......Page 554
R......Page 555
S......Page 556
V......Page 557
W......Page 558
Z......Page 559
A......Page 560
C......Page 561
E......Page 564
I......Page 565
L......Page 567
M......Page 568
N......Page 569
P......Page 570
R......Page 571
S......Page 572
T......Page 574
W......Page 575
Z......Page 576

Citation preview

fifth edition

Language Disorders A Functional Approach to Assessment and Intervention Robert E. Owens, Jr. State University of New York at Geneseo

Boston • New York • San Francisco Mexico City • Montreal • Toronto • London • Madrid • Munich • Paris Hong Kong • Singapore • Tokyo • Cape Town • Sydney

Executive Editor and Publisher: Stephen D. Dragin Series Editorial Assistant: Anne Whittaker Marketing Manager: Jared Brueckner Production Editor: Cynthia Parsons Editorial Production Service: Publishers’ Design and Production Services, Inc. Manufacturing Buyer: Linda Cox Electronic Composition: Publishers’ Design and Production Services, Inc. Interior Design: Publishers’ Design and Production Services, Inc. Photo Researcher: Annie Pickert Cover Administrator: Elena Sidorova For related titles and support materials, visit our online catalog at Copyright © 2010, 2004, 1999, 1995, 1991 Pearson Education, Inc. All rights reserved. No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. To obtain permission(s) to use material from this work, please submit a written request to Allyn and Bacon, Permissions Department, 501 Boylston Street, Suite 900, Boston, MA 02116 or fax your request to 617-671-2290. Between the time website information is gathered and then published, it is not unusual for some sites to have closed. Also, the transcription of URLs can result in typographical errors. The publisher would appreciate notification where these errors occur so that they may be corrected in subsequent editions. Library of Congress Cataloging-in-Publication Data Owens, Robert E. Language disorders : a functional approach to assessment and intervention / Robert E. Owens, Jr. — 5th ed. p. cm. Includes bibliographical references and index. ISBN-13: 978-0-205-60764-8 (alk. paper) ISBN-10: 0-205-60764-0 (alk. paper) 1. Language disorders in children. I. Title. RJ496.L35O94 2010 618.92'855—dc22 2008046593 Printed in the United States of America 10 9 8 7 6 5 4 3 2


13 12 11 10

Photo credits: p. 3, IndexOpen; p. 21, Lauren Shear/Photo Researchers; p. 69, Laura Bolesta/Merrill Education; p. 99, David Mager/Pearson Learning Photo Studio; p. 121, BSIP/Phototake NYC; p. 145, Michelle Bridwell/ PhotoEdit; p. 176, David Young-Wolff/PhotoEdit; p. 216, Myrleen Ferguson Cate/PhotoEdit; p. 241, Ellen Senisi/ The Image Works; p. 266, Image 100 RF; p. 282, Steve Warmowski/The Image Works; p. 339, Bob Daemmrich Photography, Inc.; p. 375, Eric Fowke/PhotoEdit




Part 1 Introduction 1


A Functional Language Approach


Role of Pragmatics in Intervention 8 Dimensions of Communication Context 9 Summary 10 Role of Generalization in Intervention 10 Variables That Affect Generalization 11 Summary 17 Evidence-Based Practice 17 Conclusion 19


Language Impairments


Diagnostic Categories 22 Information Processing 24 Mental Retardation or Intellectual Disability 26 Language Learning Disability 34 Specific Language Impairment 41 Pervasive Developmental Disorder/Autism Spectrum Disorder Brain Injury 55 Maltreatment: Neglect and Abuse 57 Other Language Impairments 61 Conclusion 63 Implications 64

Part 2 Communication Assessment 3



Assessment of Preschool and School-Age Children with Language Impairment 69 iii



Psychometric Versus Descriptive Procedures 71 Psychometric Assessment Protocols 73 Test Differences 74 Content 74 Misuse of Normative Testing 75 Variables in Test Selection 79 Summary 80 Descriptive Approaches 80 Reliability and Validity 81 Summary 83 An Integrated Functional Assessment Strategy 83 Questionnaire, Interview, and Referral 84 Observation 85 Formal Testing 87 Sampling 97 Assessment for Information-Processing Deficits 98 Conclusion 98


Assessment of Preschool and School-Age Children with Language Difference 99 State of Service Delivery 101 Lack of Preparation and Experience 101 Unfamiliarity with Language and Culture 101 Lack of Appropriate Assessment Tools 106 Overcoming Bias in an Assessment 107 Use of Interpreters 108 Alternative Assessment 110 An Integrated Model for Assessment 111 Children with LEP 112 Children with Different Dialects 118 Summary 120 Conclusion 120


Language Sampling


Planning and Collecting a Representative Sample 122 Representativeness 122 A Variety of Language Contexts 123 Evocative Conversational Techniques 128 Language Sampling of Children with CLD Backgrounds Recording the Sample 138 Transcribing the Sample 140 Collecting Samples of Written Language 143 Conclusion 143




Analysis Across Utterances and Partners and by Communication Event 145 Across Utterances and Partners 147 Stylistic Variations 147 Referential Communication 148 Cohesive Devices 151 Communication Event 153 Social Versus Nonsocial 154 Conversational Initiation 155 Topic Initiation 156 Conversation and Topic Maintenance Duration of Topic 161 Topic Analysis Format 162 Turn Taking 166 Conversation and Topic Termination Conversational Breakdown 170 Conversational Partner 173 Conclusion 175



Analyzing a Language Sample at the Utterance Level Language Use 177 Disruptions 178 Intentions 179 Content 184 Lexical Items 185 Word Relationships 187 Figurative Language 190 Word Finding 191 Form 192 Quantitative Measures 192 Syntactic and Morphological Analysis Conclusion 215



Narrative Analysis


Scripts and Narrative Frames 218 Collecting Narratives 218 Narrative Analysis 220 Narrative Levels 221 High-Point Analysis 222 Story Grammars 224 Expressive Elaboration 227 Quantitative Measures 229 Cohesive Devices 230






Reliability and Validity 232 Children with CLD Backgrounds Narrative Collection and Analysis Conclusion 236

Part 3 Intervention 9

233 235


A Functional Intervention Model


Principles 243 The Language Facilitator as Reinforcer 243 Close Approximation of Natural Learning 244 Following Developmental Guidelines 244 Following the Child’s Lead 246 Active Involvement of the Child 247 Heavy Influence of Context on Language 247 Familiar Events Providing Scripts 247 Designing a Generalization Plan First 248 Generalization Variables 248 Training Targets 248 Training Items 250 Method of Training 252 Language Facilitators 255 Training Cues 262 Contingencies 263 Location 264 Conclusion 265


Manipulating Context


Nonlinguistic Contexts 267 Linguistic Contexts 269 Modeling 270 Direct Linguistic Cues 272 Indirect Linguistic Cues 273 Contingencies 274 Top-Down Teaching 279 Conclusion 281


Specific Intervention Techniques Pragmatics 283 Intentions 284 Conversational Abilities




Narration 295 Semantics 299 Inadequate Vocabulary 300 Semantic Categories and Relational Words Word Retrieval and Categorization 311 Comprehension 315 Syntax and Morphology 322 Morphology 323 Verb Tensing 323 Pronouns 327 Plurals 328 Articles 328 Prepositions 329 Word Order and Sentence Types 330 Summary 331 Children with CLD Backgrounds 333 Use of Microcomputers 336 Conclusion 338


Classroom Functional Intervention



Background and Rationale: Recent Educational Changes Inclusion 341 Collaborative Teaching 342 Summary 343 Role of the Speech-Language Pathologist 344 Relating to Others 344 Language Intervention and Language Arts 345 Elements of a Classroom Model 346 Identification of Children at Risk 346 Curriculum-Based Intervention 353 Linguistic Awareness Intervention Within the Classroom Language Facilitation 365 Instituting a Classroom Model 370 Conclusion 374


Literacy Impairments: Language in a Visual Mode Reading 377 Reading Problems 377 Children with CLD Backgrounds Assessment of Reading 380 Intervention for Reading Impairment Writing 397 Writing Problems 397

379 385







Assessment of Writing 399 Intervention for Writing Impairment Conclusion 408


Appendices A

Considerations for CLD Children


Language Analysis Methods


Selected English Morphological Prefixes and Suffixes


Indirect Elicitation Techniques


Intervention Activities and Language Targets


Use of Children’s Literature in Preschool Classrooms Glossary References Author Index Subject Index

467 471 535 549

409 419 443

445 449 453



he fifth edition of Language Disorders: A Functional Approach to Assessment and Intervention represents an exhaustive compilation of studies conducted by my professional colleagues and of several years of my own clinical work in speech-language pathology with both presymbolic and symbolic children and adults. In this book, I concentrate on children because of the special problems they exhibit in learning language. Adults who are acquiring language, or who have lost language and are attempting to regain it, represent a diverse group that would be difficult to address also in this text. I call the model of assessment and intervention presented in this text functional language. This approach goes by other names, such as environmental or conversational, and includes elements of several other models. Where I have borrowed someone’s model, ideas, or techniques, full credit is given to that person. I find assessment and intervention to be an adaptation of a little of this and a little of that within an overall theoretical framework. Readers should approach this text with this in mind. Some ideas presented are very practical and easy to implement, whereas others may not apply to particular intervention settings. Readers should use what they can, keeping in mind the overall model of using the natural environment and natural conversations as the context for training language. I am the first to acknowledge that I do not have a monopoly on assessment and intervention methods, nor do I pretend to have all of the answers. Within Language Disorders, I have made some content decisions that should be explained. I group all children with language problems, both delays and disorders, under the general rubric of language-impaired. This expedient decision was made recognizing that this text would not be addressing specific disorder populations except in a tangential manner. The fifth edition differs from previous ones in four ways beyond the obvious updating with the newest research. First, there is new emphasis on evidence-based practice (EBP), as there is throughout the profession of Speech-Language Pathology. In a special section I explain EBP in easy terms for students. Second, the chapter on disorders (Chapter 2) has been expanded to include the following: syndrome in recognition of the increased numbers of children being diag• Asperger’s nosed with this disorder. newest neurological data, which is changing our understanding of many disorders. • The Increased discussion of other low-incidence causes of language impairment (LI). •




Third, I have increased discussion of children with culturally linguistically diverse (CLD) backgrounds throughout. These children are becoming an increasing portion of the preschool and school-age population in the United States. It is absolutely essential that future SLPs be aware of the issues of children with LI who come from CLD backgrounds. And finally, I have greatly expanded and rewritten the chapter on literacy (Chapter 13) because of the increasing importance of reading and writing in the caseloads of many school-based SLPs. With all this expansion, something had to go. Sadly, I have eliminated the sections on prelinguistic children and the special challenges they pose for SLPs. All is not lost, however, because I am planning to write a new text specifically addressing the needs of this population. The increasing need for early intervention (EI) dictates that we address this issue in its entirety and not as an add-on to other discussions. I hope that you will find this text useful. Those who use the methods found within these pages tell me that they and their clients find them to be useful, effective, adaptable, and fun. Time will tell if you agree.

Acknowledgments No text is written without the aid of other people. First, I thank the reviewers of this edition: Lynn Bliss, University of Houston; Louis De Maio, Minnesota State University; Adrienne McElroy-Bratcher, Eastern New Mexico University; and Kerri Phillips, Louisiana Technological University. I have tried to heed their sound advice. I also acknowledge the advice and counsel of Dr. Addie Haas, Department of Communication Disorders, State University of New York at New Paltz, a constant inspiration and breath of freshness and someone who helps me stretch my imagination and explore new possibilities. My many conference presentations and long hikes in the woods with Dr. Haas are always a learning experience and a joy. Linda Deats, a colleague at State University of New York and a dear friend, has offered constant encouragement and lots of laughs. In addition, special thanks and much love to my partner at O and M Education, Moon Byung Choon, for his patience, support, and perseverence. Other supporters include Dr. Linda House, chair, and Dr. Dale Metz and Irene Belyakov of the Department of Speech Pathology and Audiology, State University of New York at Geneseo. Finally, my deepest gratitude to Dr. James MacDonald, retired from the Department of Speech Pathology and Audiology, The Ohio State University, for introducing me to the potential of the environment in communication intervention. Thanks, Jim!

1 part



A Functional Language Approach C H A PTE R 2

Language Impairments

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A Functional Language Approach


Part 1 Introduction


t the risk of sounding like I think I’m something special, which I don’t and I’m not, let me begin with two vignettes. Several months ago I gave a presentation in Buffalo, New York, on a topic other than speech-language pathology and was pleased to see a former student sitting in the rear. Afterward, when I approached her and expressed my surprise at seeing her in attendance, she told me she was there not because of the topic but because she wanted to tell me how much she appreciated the functional intervention methodology I had shared with her in class ten years earlier. At the time, according to her, she thought I was describing a standard method of providing intervention and was not aware until she graduated just how different functional intervention is from typical intervention as practiced by her peers. She related to me that, ten years after graduating, she is still questioned by colleagues who wonder how she learned to make therapy look so natural and to engage children so well while genuinely seeming to enjoy herself. I can’t take credit for that. All I did was provide information. She is a bright, creative speech-language pathologist who was able to implement what she had learned. After another workshop in Connecticut, an older speech-language pathologist approached me to tell me she used many functional methods she had read in this book and found them to be very effective. Somewhat humbled, I thanked her, but as I moved on, she took my arm firmly and said,“You don’t understand. I get it. I get it.” As I turned back to her, she explained that functional intervention is not the same as using someone’s published language intervention program, it’s a philosophy of intervention that influences everything she does with children and adults with language impairment. Both women get it. In this book, we are going to explore that functional philosophy and how to implement it. I want you to get it too. There are many pieces to this model, but luckily, an inability to use some portions, such as working with parents, does not preclude using others, such as teaching through conversation. Nor does use of functional methods negate the need for more traditional methods with some clients and at some times during intervention. But with a functional approach firmly in your mind, you never lose sight of the goal. You never lose sight of intervention based on actual use of the newly trained skill to improve communication. All your clinical decisions move your clients in that direction. Throughout this book, to the best of my ability, I have used evidence-based practice (EBP) as the basis for this text. I have attempted to research each topic, weigh the data, and make informed decisions prior to passing the knowledge on to you. If you are unfamiliar with EBP, I’ll explain it at the end of the chapter. For now, let’s begin with the basic concepts of language impairment and functional language intervention. Language is a vehicle for communication and is primarily used in conversations. As such, language is the social tool that we use to accomplish our goals when we communicate. In other words, language can be viewed as a dynamic process. If we take this view, it changes our approach to language intervention. We become interested in the how more than in the what. It is that aspect of language intervention that I wish for us to explore through this book. The American Speech-Language-Hearing Association, the professional organization for speechlanguage pathologists, defines language disorder as follows: A LANGUAGE DISORDER is impaired comprehension and/or use of spoken, written and/or other symbol systems. This disorder may involve (1) the form of language (phonology, morphology, syntax), (2) the content of language (semantics), and/or (3) the function of language in communication (pragmatics) in any combination. (Ad Hoc Committee on Service Delivery in the Schools, 1993, p. 40)

Chapter 1

A Functional Language Approach


For our purposes, we shall consider the term language impairment to apply to a heterogeneous group of developmental disorders, acquired disorders, delays, or any combination of these principally characterized by deficits and/or immaturities in the use of spoken or written language for comprehension and/or production purposes that may involve the form, content, or function of language in any combination. Language impairment may persist across the lifetime of the individual and may vary in symptoms, manifestations, effects, and severity over time and as a consequence of context, content, and learning task. Language differences, such as those found in some individuals with limited English proficiency and with different dialects, do not in themselves constitute language impairments. In attempting to clarify the definition of language impairment, we have, no doubt, raised more questions than we have answered. For example, causal factors, such as prematurity, although important, are omitted from the definition because of their diverse nature and the lack of clear causal links in many children with language impairment (LI). In general, causal categories are not directly related to later language attributes (Lahey, 1988). Likewise, diagnostic categories, such as mental retardation, are not included in my definition for many of the same reasons. The definition also states that language differences are not disorders or delays, even though the general public and some professionals often confuse them. We explore all of these issues in Chapter 2 and the chapters that follow. For now, relax a little. The professional with primary responsibility for habilitation or rehabilitation of language impairment is the speech-language pathologist (SLP). The wearer of many hats, the SLP serves as team member, team teacher, teacher and parent trainer, and language facilitator. These many roles reflect a growing recognition that viewing the child and his or her communication as the problem is an outmoded concept, and increasingly, language intervention is becoming family centered or environmentally based, such as in a classroom. Professional concern is shifting from training targets such as individual morphological endings or vocabulary words to a more functional, holistic approach and broadening to a concern for the child’s overall communication effectiveness. A functional language approach to assessment and intervention, as described in this text, targets language used as a vehicle for communication. A functional approach is a communication-first approach. The focus is the overall communication of the child with language impairment and of those who communicate with the child. As stated, the goal is better communication that works in the client’s natural communicative contexts. An SLP needs to ensure that the language skills that are targeted and trained generalize to the everyday environment of the child. This concern for language use necessitates a new primacy for pragmatics and the interrelatedness of all aspects of language in intervention protocols. If all aspects of language are interrelated, then changes in one area affect others. For example, development in phonology (/s/) may affect morphological markers (plural -s). Syntactic growth may affect pragmatics. In intervention, such changes may not be spontaneous and must not be taken for granted. In general, it is best if an SLP not focus intervention solely in one aspect, such as syntax, to the exclusion of other aspects, such as pragmatics. In short, in a functional language approach, conversation between children and their communication partners becomes the vehicle for change. By manipulating the linguistic and nonlinguistic contexts within which a child’s utterances occur, the partner facilitates the use of certain structures and provides evaluative feedback while maintaining the conversational flow. From the early data collection stages through target selection to the intervention process, the SLP and other communication partners are concerned with the enhancement of overall communication.


Part 1 Introduction

Functional language approaches have been used to increase mean length of utterance and multiword utterance production; the overall quantity of spontaneous communication; pragmatic skills; vocabulary growth; language complexity; receptive labeling; and intelligibility and the use of trained forms in novel utterances in children with mental retardation, autism, specific language impairment, language learning disability, developmental delay, emotional and behavioral disorders, and multiple handicaps (Camarata, Nelson, & Camarata, 1994; Dyer, Williams, & Luce, 1991; Girolametto, 1988; Nye, Foster, & Seaman, 1987; Scherer & Olswang, 1989; Schwartz, Chapman, Terrell, Prelock, & Rowan, 1985; Theadore, Maher, & Prizant, 1990; Whitehurst, Fischel, Lonigan, Valdez-Menchaca, Arnold, et al., 1991). Even minimally symbolic children who require a more structured approach benefit from a conversational milieu (Owens, McNerney, Bigler-Burke, & Lepre-Clark, 1987; Yoder, Warren, et al., 1994). In addition, functional interactive approaches improve generalization even when the immediate results differ little from those of more direct instructional methods (Cole & Dale, 1986; RogersWarren & Warren, 1985; Warren & Kaiser, 1986a). Finally, a conversational approach yields more positive behaviors from the child, such as smiling, laughing, and engagement in activities, with significantly more verbal initiation, than does an imitation approach. In contrast, the child learning through an imitation approach is more likely to be quiet and passive (Haley, Camarata, & Nelson, 1994). In the past, language-training programs have focused on language form and content, with little consideration given to pragmatics or language use. As you know, form consists of syntax, morphology, and phonology; content is semantics or meaning; and pragmatics is use. The typical approach to teaching language forms has been a highly structured, behavioral one emphasizing the teaching of specific behaviors within a stimulus-response-reinforcement model (Fey, 1986). Thus, language is not a process but a product or response elicited by a stimulus or produced in anticipation of reinforcement. Stimulus-response-reinforcement models of intervention often take the form of questions by an SLP and answers by a child or directives by an SLP for a child to respond. Typical stimulus utterances by an SLP might include the following: Which one sounds better . . . or. . . . ? Did I say that correctly? Tell me the whole thing. Say that three times correctly. Consequences are based on the correctness of production and might include Good, Good talking, Repeat it again three times, Listen to me again, and so on. Table 1.1 contrasts the more structured, stimulus-response-reinforcement paradigm with a more functional approach. Many SLPs prefer structured approaches because they can predict accurately the response of the child with LI to the training stimuli. In addition, structured behavioral approaches increase the probability that the client will make the appropriate, desired response. Language lessons usually are scripted as drills and, therefore, are repetitive and predictable for the SLP. The child can become a passive learner as the SLP manipulates structured stimuli in order to elicit responses and dispense reinforcement. The SLP’s overall style is highly directive (Ripich & Panagos, 1985; Ripich & Spinelli, 1985). In other words, the clinical procedure is unidirectional. These “traineroriented” approaches (Fey, 1986) are inadequate for developing meaningful uses for the newly acquired language feature. Structured behavioral approaches that exhibit intensity, consistency, and organization have been successful in teaching some language skills. A major problem is generalization from clinical to more

Chapter 1


A Functional Language Approach


Comparison of Traditional and Functional Intervention Models

Traditional Model

Functional Model

Individual or small group setting using artificial situations. Isolated linguistic constructs with little attention to the interrelationship of linguistic skills.

Individual or small- or large-group setting within contextually appropriate setting. Relationship of aspects of communication stressed through spontaneous conversational paradigm.

Intervention stresses modeling imitation, practice, and drill.

Conversational techniques stress message transmission and communication.

Little attention to the use of language as a social tool during intervention sessions.

The use of language to communicate is optimized during intervention sessions.

Little chance or opportunity to develop linguistic constructs not targeted for intervention.

Increased opportunity to develop a wide range of language structures and communication skills through spontaneous conversation and social interaction. Increased opportunity to develop communication skills by interacting with a wide variety of partners.

Little opportunity to interact verbally with others during intervention. Source: Adapted from Gullo & Gullo (1984).

natural contexts (Hunt & Goetz, 1988). For example, failure of language-training targets to generalize to other uses is one of the major criticisms of intervention with children with autism spectrum disorders (discussed in Chapter 2) (Koegel, 1995). Lack of generalization can be a function of the material selected for training, the learning characteristics of a child, or the design of the training. Stimuli present in the clinical setting that directly or indirectly affect the behavior being trained may not be found in other settings. Some of these stimuli, such as training cues, have intended effects, whereas others, such as an SLP’s presence, may have quite unintended ones. In addition, clinical cues or consequences used for teaching may be very different from those encountered in everyday situations, thus removing the motivation to use the behavior elsewhere. In contrast, functional approaches give more control to a child and decrease the amount of structure in intervention activities. Indices of improvement are in increased successful communication, rather than in the number of correct responses. Procedures used by an SLP and a child’s communication partners more closely resemble those in the language-learning environment of children developing typically. In addition, the everyday environment of a child with LI is also included in training. Naturally, the effectiveness of any language-teaching strategy will vary with the characteristics of the child with LI and the content of training. For example, children with learning disabilities seem to benefit more from specific language training than do other children with language impairment (Nye et al., 1987). Likewise, children with more severe LI initially benefit more from a structured imitative approach. In this chapter, we explore a rationale for a functional language approach. This rationale is based on the primacy of pragmatics in language and language intervention and on the generalization of language intervention to everyday contexts. Generalization is discussed in terms of the variables that influence it.


Part 1 Introduction

Role of Pragmatics in Intervention Pragmatics consists of the intentions or communication goals of each speaker and of the linguistic adjustments made by each speaker for the listener in order to accomplish these goals. Most features of language are affected by pragmatic aspects of the conversational context. For example, the selection of pronouns, verb tenses, articles, and adverbs or adverbial phrases of time involves more than syntactic and semantic considerations. The conversational partners must be aware of the preceding linguistic information and of each other’s point of reference. An earlier interest by SLPs in psycholinguistics has led to the present therapeutic emphasis on increasing syntactic complexity. An SLP’s role has been to discover each child’s individual learning strategies and to use these within the unidirectional, SLP-directed approach mentioned previously. With the therapeutic shift in interest to semantics or meaning in the early 1970s came a new recognition of the importance of cognitive or intellectual readiness but little understanding of the importance of the social environment. Most intervention approaches maintained structural behavioral teaching techniques. Cognitive process-based approaches were ignored or nonexistent. The influence of sociolinguistics and pragmatics in the late 1970s and 1980s has led to interest in conversational rules and contextual factors. Everyday contexts have provided a backdrop for explanations of linguistic performance. Among those working with special populations, the focus shifted to the communication process itself. Previously, for example, children’s behaviors were considered either appropriate or inappropriate to the stimulus-reinforcement situation, rather than as a part of the interaction. Echolalia and unusual language patterns considered inappropriate were extinguished or punished. When emphasis shifts to pragmatics and to the processes that underlie behavior, however, the child’s language, even echolalia, can be considered on its own terms. Older approaches tend to emphasize childrens’ deficits with the goal of fixing what’s wrong (Duchan, 1997). In contrast, a functional approach stresses what a child needs in order to accomplish his or her communication goals. It follows that intervention should provide contexts for actively engaging children in communication. In shifting the focus from the disorder to supporting a child’s communication, the goal becomes increasing support and opportunities for the child to participate in everyday communication situations. The natural outgrowth is to involve families and teachers in training programs. The traditional, or formalist, view of language—as a composite of various rule systems, consisting of syntax, morphology, phonology, semantics, and pragmatics (Figure 1.1)—may be inadequate. This approach has given way to a functional model and to a more holistic approach to intervention. Language is a social tool, and, as such, considerations of its use are paramount. The formalist model has been replaced by one in which pragmatics is the overall organizing framework. Increasingly, SLPs are recognizing that structure and content are influenced heavily by the conversational constraints of the communication context. This view of language necessitates a very different approach to language intervention. In effect, intervention has moved from an entity approach, which targets discrete isolated bits of language, to a systems or holistic approach, which targets language within the overall communication process (Norris & Hoffman, 1990a). The major implication is a change in both the targets and the methods of training. If, as formalists contend, pragmatics is just one of five equal aspects of language, then it offers yet another set of rules for training. Thus, there will be additional training goals, but the methodology need

Chapter 1

A Functional Language Approach








logy Phon o



phol Mor

Semantics Sema


tics gma


Pragmatics is one of five equal and interrelated aspects of language.

Pragmatics is the overall organizing aspect of language.

FIGURE 1.1 Relationship of the aspects of language.

not change. The training still can emphasize the what with little change in the how, which can continue in a structured behavioral paradigm. In contrast, an approach in which pragmatics is the organizing aspect of language necessitates a more interactive conversational training approach, one that mirrors the environment in which the language will be used. Therapy becomes bidirectional and child oriented, and conversation is viewed as both the teaching and transfer environment. DI M E NSIONS OF COM M U N ICATION CONTEXT Language is purposeful and takes place within a dynamic context. Context affects form and content and may, in turn, be affected by them. Context consists of a complex interaction of the following eight factors (Dudley-Marling & Rhodes, 1987): Purpose. Language users begin with a purpose that affects what to say and how to say it. Content. We use language to communicate about something. The topic of discourse will affect the form and the style. Type of discourse. Certain types of discourse, such as a debate or a speech, use a characteristic type of structure related to the purpose. Participant characteristics. Participant characteristics that affect context are background knowledge, roles, life experiences, moods, willingness to take risks, relative age, status, familiarity, and relationship in time and space. Setting. Setting includes the circumstances under which the language occurs. Activity. The activity in which the language users are engaged will affect language, especially the choice of vocabulary.


Part 1 Introduction

Speech community. The speech community is that group with whom we share certain rules of language. It may be as large as the speakers of a language, such as English, or as small as two people who share a secret language of their own. Mode of discourse. The purpose and the relations of language users in time and space usually are determined by the mode of discourse. Speech and writing are modes that require very different types of interaction from the participants. Within a conversation, participants continually must assess these factors and their changing relationships. An SLP must be a master of the conversational context. Unfortunately, it is too easy to rely on overworked verbal cues, such as “Tell me about this picture” or “What do you want?” to elicit certain language structures. As simple a behavior as waiting can be an effective intervention tool when appropriate. Similarly, a seemingly nonclinical utterance, such as “Boy, that’s a beautiful red sweater,” can easily elicit negative constructions when directed at a child’s green socks. SLPs who know the dimensions of communication context understand these dimensions more effectively and manipulate them more efficiently. SU M MARY In the clinical setting, SLPs need to be aware of the effects of context on communication. How well children with LI regulate their relationships with other people depends on their ability to monitor aspects of the context. Given the dynamic nature of conversational contexts, it is essential that intervention also address generalization to the child’s everyday communication contexts.

Role of Generalization in Intervention One of the most difficult aspects of therapeutic intervention in speech-language pathology is generalization, or carryover, to nontraining situations (Fey, 1988; Halle, 1987; Hunt & Goetz, 1988; Warren, 1988). For our purposes, let us consider generalization to be the ongoing interactive process of clients and of their newly acquired language feature with the communication environment (Figure 1.2). For example, if we are trying to teach a child the new word doggie, we might repeat the word several times in the presence of the family dog and then cue the child with “Say doggie.” If the child repeats the word only in this situation, she has not learned to use the word. If she says the word spontaneously and in the presence of other dogs, however, then we can reasonably assume that the child can produce the word without a model and thus has learned the word. The trained content has generalized. The factors that affect generalization lie within the training content, the learner, and the teaching program and environment but will vary as particular aspects of the teaching situation change. If a response is to occur in a nontraining situation, such as a classroom, then some aspects of that situation should be present in the training situation to signal that the response should occur. In other words, an SLP must consider the effects of the various teaching contexts on generalization to everyday contexts. Time and again, we SLPs bemoan the fact that although Johnny performed correctly in therapy, he could not transfer this performance to the playground, classroom, or home. When language features taught in one setting are not generalized to other content and contexts, the goal of communicative competence is not realized.

Chapter 1

A Functional Language Approach


Newly learned behavior or language feature



Generalization is the interaction of the individual, the newly trained behavior or language feature, and the environment. All three must be present for generalization to occur.

FIGURE 1.2 Generalization schematic.

Some SLPs hope that the training will generalize but exercise little influence over that possibility. This condition reflects a failure to manipulate the variables that affect generalization. Language training may not generalize because it is taught out of context, represents neither a child’s communicative functions nor linguistic knowledge or experiences, or presents few communicative opportunities. To some extent, generalization is also a result of the procedures used and of the variables manipulated in language training. Finally, the very targets chosen for remediation may contribute to a lack of carryover. With each client, an SLP needs to ask: Will this procedure (or target) work in the child’s everyday environment? Is there a need within the everyday communication of the client for the feature that is being trained, and do the methods used in its teaching reflect that everyday context? In a recent meeting with a student SLP, the answer to these questions was no. As a result, we decided to forgo auxiliary verb training with a middle-aged adult with mental retardation in favor of communication features more likely to be used within the client’s everyday communication environment, such as ordering at a fast-food restaurant, asking directions, and using the telephone. In other words, we opted for a more functional approach that targeted useful skills in the everyday environment of the client. VAR IAB LES THAT AFFECT G E N E RALIZATION Generalization is an essential part of learning. Even the young child using his or her first word must learn to generalize its use to novel content. At first the word doggie may be used with other four-legged


Part 1 Introduction

animals. Eventually, the child abstracts those cases in which the word doggie is correct and those in which it is not. The child is learning those contexts that obligate the use of doggie and those that preclude its use. Contexts regulate application of language rules. Likewise, a young child who can say,“May I have a cookie, please?” has not learned this new utterance until it is used in the appropriate contexts. A child learns the appropriate contextual cues, such as the presence of cookies, that govern use of the utterance. The contexts in which training takes place influence what a child actually learns. In fact, correctness is not inherent in a child’s response itself but is found in the response in context. Saying “May I have a cookie, please?” when none are available is inappropriate. The relationship of context to learning is not a simple one, and the stimuli controlling a response may be multiple. Generalization is also an integral part of the language intervention process. Thoughts on generalization should not be left until after the intervention program is designed. Generalization is not a single-line entry at the end of the lesson plan, nor is it homework. To facilitate the acquisition of truly functional language—language that works for the child—it is essential that SLPs manipulate the variables related to generalization throughout the therapeutic process. In the functional model, generalization is an essential element at every step. Table 1.2 includes a list of the major generalization variables. Generalizations are of two broad types: content generalization and context generalization. Content is the what of training. Content generalization occurs when the child with LI induces a language rule from examples and from actual use. Thus, the new feature (e.g., plural -s) may be used with content not previously trained, such as words not used in the therapy situation. Content generalization is affected by the targets chosen for training, such as the use of negatives, and by the specific choice of training items, such as the words and sentences used to train negation. Overall, the content selected for training reflects an SLP’s theoretical concept of language and of strategies for learning and the communication needs of a child. When grammatical units are targeted, different uses or functions for those units are essential to meet a child’s needs. If content is the what, context is the how of training. Context generalization occurs when the client uses the new feature, such as the use of auxiliary verbs in questions, within everyday communication, such as in the classroom, at home, or in play. In each of these contexts are differences in persons present and in the location, as well as in the linguistic events that precede and follow the newly learned behavior. Generalization can be facilitated when the communication contexts of the training environment and of the natural environment are similar in some way. Context includes an intrapersonal component unique to each individual and an interpersonal component shared by all persons in the communication setting (Spinelli & Terrell, 1984). Intrapersonal TABLE 1.2

Variables That Affect Generalization of Language Training

Content generalization

Training targets Training items

Context generalization

Method of training Language facilitators Training cues Consequences Location of training

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A Functional Language Approach


variables include each partner’s cognitive and social knowledge or context, variables that may differ greatly. These variables influence intervention decisions on the selection of content and the individualization of program design. Interpersonal variables include situational factors (e.g., method of training, personnel involved, training cues, reinforcement method, location and time of training, and objects present) and participant factors (e.g., conversational roles of the participants). The effects of some of these variables on generalization are discussed in detail in the following sections. Training Targets The very complexity of language makes it impossible for an SLP to teach everything that a child with LI needs to become a competent communicator. Obviously, some language features must be ignored. Target selection, therefore, is a conscious process with far-reaching implications. Training target selection should be based on the actual needs and interests of each child within his or her communication environments. The focus of instruction should be on increasing the effectiveness of child-initiated communication. Because language is a dynamic process that is influenced heavily by context, language features selected for training should be functional or useful for the child in the communication environment. Although there is a tendency for beginning SLPs to target specific language deficits, such as plural -s, as an end in itself, intervention goals must focus on stimulating the language acquisition process beyond the immediate target (Fey, Long, & Finestack, 2003). We can best serve children with LI if we enhance each child’s existing resources for learning language more effectively not only within the intervention context but beyond. Not all language features occur with equal frequency. It may be necessary, therefore, to create more frequent opportunities for a feature to occur. An SLP must create activities and modify the environment to increase the need for the target feature. Generalization is also a function of the scope of the training target and of the child’s characteristics and linguistic experience with the target. In general, language rules with broad scope generalize more easily than those with more restricted scope (Kamhi, 1988). The scope of rule application can be a function of the way it is taught. Narrow, restricted teaching reduces training targets to easily identifiable and observable units. Rules interpreted by a child as applying to a limited set of items combined in a very specific manner will involve little generalization (Johnston, 1988a). The child’s prior knowledge of language also influences generalization. The failure of training to generalize may reflect training targets that are inappropriate for the knowledge level of a child. For example, it would be inappropriate to train indirect commands (e.g., can you . . . ?) prior to the child’s understanding and using yes/no questions and direct commands. In conclusion, training targets should be selected on the basis of each child’s actual communication needs and abilities, rather than on some preconceived agenda. The targets selected for training should be functional or useful in a client’s everyday communication environment. Training Items The actual items selected for intervention, such as the specific verbs to be used in training the past tense or the sentences to be used in training negation, and the linguistic complexity of these intervention


Part 1 Introduction

items also can influence generalization. In general, it is best if these items come from the natural communication environment of the child with LI. Structured observation of this environment can aid intervention programming. For example, an active child may use the verbs walk, jump, and hop frequently. It is more likely that use of the past-tense -ed will generalize if these frequently occurring words are used in the training. Individualization is important because of the many potentially different use environments. A child who is institutionalized may have very different content to discuss than does a child who resides at home. The interests of younger children are also very different from those of adolescents. Targeted linguistic forms, whether word classes or larger linguistic structures, can be trained across several functions. For example, negatives used with auxiliary verbs can occur in declaratives (“That doesn’t fit”), imperatives (“Don’t touch that”), and interrogatives (“Don’t you want to go?”) and in functions, such as denying (“I didn’t do it”) or requesting information (“Why didn’t you go?”). For optimum generalization, then, it is necessary to select training items from a child’s everyday environment. In addition, these items should be trained across linguistic forms and/or functions and across linguistic and nonlinguistic contexts. Method of Training The training of discrete bits of language devoid of the communication context actually may retard learning and growth (Damico, 1988; N. Nelson, 1993). Such fragmentation allows minute analysis units to eclipse the essential language qualities of intentionality and synergy (Damico, 1988). In other words, language use in communication is lost. Intervention that focuses on these specific, discrete, structural entities fosters drills and didactic training. These adversely affect the flow, intentionality, and meaningfulness of language (Oller, 1983). If language is viewed holistically, then the training of language involves much more than just training words and structures. Clients learn strategies for comprehending language directed at them and for generating novel utterances within several conversational contexts. Training should occur in actual use within a conversational context. Prutting (1983) states that language intervention should meet the “Bubba” criterion. Bubba is Yiddish for “grandmother.” If we were to explain our intervention approach to our Jewish grandmother, she would reply: “Oh, I could have told you that. It just makes sense to use conversations to train. Why didn’t you ask me?” In other words, the training regimen should make sense. Training in context makes sense. Our intervention methodology should flow logically from our concept of language. If language is a social tool and if the goal is to train for generalized use, then it follows that language should be trained in conditions similar to the ultimate use environment. Thus, an SLP modifies the interactional context within which language is trained so that it closely resembles or actually takes place within a child’s ongoing everyday communication. It is important, therefore, to view context not as a backdrop but as an ongoing process. Conversational methods alone will not guarantee success for every child with LI. For example, children with ASD, previously called autism, can improve social relationships better through a combination of peer training and written text cueing than by either method singularly (Thiemann & Goldstein, 2004). An SLP can blend these methods together as required by a child in order to be successful. Discussion of the method of training leads naturally to consideration of the other contextual variables. For optimum generalization, training should occur within a conversational context with varying numbers of facilitators, cues, consequences, and locations.

Chapter 1

A Functional Language Approach


Language Facilitators Language facilitators are “adults who increase the child’s potential for communication success” (Craig, 1983, p. 110). Parents, teachers, aides, and unit personnel, in addition to the SLP, should act as language facilitators because of their relationship with and the amount of time each spends with the child. Interactional partners form communication environments for each other, and it is essential that the client experience newly learned language in a number of these. Because language is contextually variable, it will differ within the context created by a child with each communication partner. Thus, generalization depends on the number of communication partners we can involve in the intervention process (Craig, 1983). For children developing typically, the number of individuals they see during the day or week is positively correlated with the rate of language development (K. Nelson, 1973). Programs that involve a child’s communication partners, especially parents, produce greater gains for children than do programs that do not. Parents offer a channel for generalizing to the natural environment of the home. With parent or caregiver training, both parents and teachers can function on a continuum from paraprofessionals to general language facilitators (Adler, 1988; McDade & Varnedoe, 1987; Owens, 1982d). The key in working with families, especially in early intervention with infants and toddlers, is mutual respect and individualization of services based on each family’s priorities and concerns (Sandall, McLean, & Smith, 2001). Some cultural beliefs may be at variance with the use of parents as language facilitators. For example, some Mexican American mothers believe that schools have the main responsibility for educating children and that parents should not be actively involved (Rodriguez & Olswang, 2003). These same mothers are more likely than Anglo American mothers to attribute LI to factors external to the child, such as God’s will or a child–school mismatch. Still, these mothers can eventually be enticed into taking an active role in language intervention if an SLP builds positive rapport and collaboration and is respectful of culturally held beliefs. Intervention need not be limited to just families. When daycare staff are trained to respond to children’s initiations, to engage children, to model simplified language, and to encourage peer interactions, it has a significant effect on the language production of preschool children (Girolametto, Weitzman, & Greenberg, 2003). With these additional language facilitators, the traditional role of an SLP changes. In essence, the SLP becomes a programmer of a child’s environment, manipulating the variables to ensure successful communication and generalization. To be effective, an SLP needs to recognize that a child’s communication partners are also clients, as well as agents of change (MacDonald, 1985). The SLP acts as a consultant, helping each child-parent dyad fine-tune its conversational behaviors. Training Cues Goals for the child should include both initiating and responding behaviors in the situations in which each is appropriate. Therefore, an SLP considers training language through a great variety of both linguistic and nonlinguistic cues. For example, results of several studies of intervention with young children with autism spectrum disorder (ASD) indicate that those interventions that are most successful use modification of the natural environment to prompt and cue communication and use natural reinforcers. The adult encourages child utterances by subtle manipulation of the context and responds to the child in a conversational manner. A functional language approach adapts these techniques as naturally as possible to intervention.


Part 1 Introduction

Contingencies The nature of the reinforcement used in training is also a strong determiner of generalization. Everyday, natural consequences are best. If the child requests a paintbrush, she should be given one, unless, of course, there is a good reason not to give it. If that is the case, then the child should not have been required to learn that request. Weaning the child away from edible or tangible reinforcers in favor of social ones is commendable as long as the social reinforcer is found in the natural communication environment. Verbal or social training consequences such as “Good talking,” encountered only rarely in the course of everyday conversations, should be discontinued as soon as possible in favor of more natural responses. Verbal responses that combine feedback about correctness/incorrectness with additional information can be both a language-learning opportunity and a communicative turn while maintaining the conversational flow. “Good talking” ends social interaction by commenting on the correctness of the child’s utterance only and leaving little that the child can say in return. Not every utterance is reinforced in the natural environment. In the course of everyday conversations, many utterances are not reinforced. In typical language intervention, however, every utterance by the child may be reinforced. Behaviors continuously reinforced are easy to extinguish. Intermittently reinforced responses are much more resistant and more closely resemble patterns found in the real world. Location The location of training involves not only places but also events. For maximum generalization, language should be trained in the locations, such as the home, clinic, school, or unit, and in the activities in which it is used, such as play or household chores. Children removed from familiar contexts may not exhibit their most creative language uses (Lieven, 1984). Language should be trained within the daily activities of the client. Daily routines can provide a familiar framework within which conversation can occur. The familiar situation provides a frame that allows for a degree of automatization important in the acquisition of such skills as language. Often called incidental teaching, this approach attempts to ensure that children learn and have ample opportunity to use language within naturally occurring activities (McCormick, 1986; Owens, 1982d; Warren & Rogers-Warren, 1985). Generalization increases with the similarity of the original learning situation to the transfer situation. If the conditions for training and use are the same, the need for contrived generalization strategies is alleviated. In addition, embedding intervention within the everyday routines and activities of the home or classroom focuses on generalization while reducing the stress for families and teachers that accompanies specialized training procedures (Dunlap & Fox, 1999). The ideal training situation is one in which a child with LI is engaged in some meaningful activity with a conversational partner who models appropriate language forms and functions (Staab, 1983). In this way, a child learns language in the conversational context in which it is likely to occur. It is within these everyday events that language is acquired naturally and to these events that the newly trained language is to generalize. Within these daily events are naturally occurring communication sequences (Craig, 1983). Daily events, such as phone calls, friendly meetings, dinner preparation, and even dressing, can provide a framework for language and for language training. The frame provides a guide to help the participants organize their language and their language learning. Routines and familiar situations provide support

Chapter 1

A Functional Language Approach


(Lieven, 1984). An SLP can plan conversational roles and language training through the use of such daily events.

SU M MARY A basic goal of intervention should be to help a child achieve greater flexibility in the learning and use of language in written and oral modalities of comprehension and production. Such language intervention can be a dynamic process of exchange that occurs during natural events in different environments and with different conversational partners. Reinforcement can be the intrinsic conversational success of a child. The variables relative to content and context can, if manipulated carefully, facilitate generalization of newly learned language features and make intervention seem more natural. Unfortunately, in practice, generalization is too often the final step in planning client training. Instead,“communication goals and effects should be preserved and considered the first, pervasive, and most basic step in intervention planning” (Craig, 1983, p. 110).

Evidence-Based Practice As clinicians, of course, we should be concerned with providing the best, most well-grounded intervention for our clients that is humanly possible. In other words, we should do what works or is effective. Discerning efficacy and providing the most efficacious intervention is a portion of something called evidence-based practice (EBP). In EBP, clinical decision making is informed by a combination of scientific evidence, clinical experience, and client needs. Research is combined with reason when making decisions about treatment approaches. Evidence-based practice is based on two assumptions (Bernstein Ratner, 2006): skills should grow from the current available data, not simply from experience. • Clinical The expert SLP should continually seek new therapeutic information to improve efficacy. • In the field of speech-language pathology, interest in EBP is relatively new, and there are few guidelines on providing services. Although the American Speech-Language-Hearing Association (ASHA) has established the National Center for Evidence-Based Practice in Communication Disorders, it will take years to establish comprehensive assessment and intervention guidelines. In other words, for now, EBP is a work in progress. That does not relieve SLPs of the responsibility to provide the best, most efficacious assessment and intervention possible. Until such time as guidelines do exist, SLPs need to base decisions on the best available evidence. Not all clinical evidence is created equal. Professional journals, called peer-reviewed journals, in which each submitted manuscript is critiqued by other experts in the field and accepted or rejected on the basis of the quality of the research, would seem to be the best source of information. Unfortunately, in the field of speech-language pathology, only a small percentage of the articles concern intervention efficacy. Once research has been located, an SLP is left to decide how much information is enough, how to resolve seemingly conflicting results, and how to adapt the information to individual clients.


Part 1 Introduction

It is also important for SLPs to recognize that efficacy is never an all-or-nothing proposition (Law, 2004; Rescorla, 2005). We cannot, for example, promise a “cure.”As an old-timer, I’ve had one knee and one shoulder rebuilt, and although these joints now function better than they did prior to surgery and physical therapy, they are not the joints I had when I was 20. I have regained a portion of my former strength and agility, but it is not perfect. Neither is our intervention in speech-language pathology, especially given the variables that can affect communication development. This fact makes careful understanding and application of recommended intervention techniques critical. The decision-making process in EBP is systematic and includes the following several steps (Gillam & Gillam, 2006; Perzsolt, Ohletz, Gardner, Ruatti, Meier, et al., 2003): the information needed and ask the correct clinical question. Questions should • Determine include information on the client’s performance, the environment, the intervention approach,

• •

• • •

and the desired outcomes. Find studies that address the clinical question. When searching for information, many SLPs consult the Internet. The ASHA website is a valuable resource for articles published in ASHA journals and hundreds of other affiliated journals. Effective use of the Internet is addressed below. Determine the level of evidence, and critically evaluate the studies. The quality of information differs and should be prioritized by an SLP. First-order information includes research articles in peer-reviewed professional journals. Other information, such as single-subject or small-group reports, archival records, committee reports, conference proceedings, and opinion papers, should be given less weight. In general, the best research compares the efficacy of similar groups to which children have been randomly assigned so as not to bias the results. It is best if data collectors do not know to which group children are assigned and use valid and reliable measures of performance. Finally, statistical evidence should find that, at a probability (p) of .05 or less, the results would not occur by chance. Because the p value may be meaningless at this point, and it’s beyond the scope of this text to discuss probability theory, for now just know that authors report the p value in their research. An SLP must also determine that the participants in the study compare well with the specific child in his or her clinical question. Evaluate the information for the specific case in question. Issues include the associated costs of intervention in time and money, cultural variables of the child and family, student-parent involvement and opinions, client interests, and agency policies and philosophy. Integrate the information and make a decision. Evaluate treatment outcomes to measure efficacy. Of special significance is the use of the targeted language features in everyday natural speaking situations.

These steps alone will not guarantee the best outcome, but they do provide a systematic method for decision making. Because of the potential for misinformation from many sources when researching on the Internet, it is important that an SLP use the most appropriate methods for investigating and retrieving information. Search engines such as Google and Yahoo search the entire open Internet and often provide information from secondary or tertiary sources or information that is not based on peer-reviewed research at all. It’s important to know who authored the information and/or sponsors the site, the purpose and nature of the site, and the currency of the information (Nail-Chiwetula & Bernstein Ratner, 2006). For example, a site sponsored by an intervention materials company may try to promote inter-

Chapter 1

A Functional Language Approach


vention methods using their materials. Even academic (.edu) or government (.gov) sites may present non-peer-reviewed information. For example, educational sites may present student papers submitted for specific courses. Useful professional sites include the following: The American Speech Language Hearing Association ( offers full text of all articles in its journals for ASHA or NSSLHA members. PubMed ( is a free database offered by the National Library of Medicine. Full-text articles are unavailable. Many university libraries offer several databases relevant to speech-language pathology, including CINAHL, ERIC, Language and Language Behavior Abstracts (LLBA), MEDLINE, and PsycINFO. Many offer full-text access. Abstracts do not provide sufficient information for evaluating the quality of research reported. Searches may yield thousands of entries. It is important that an SLP limit the search in order to yield only the most relevant information. For example, a search term such as autism will result in too many references to be useful, unless an SLP has years to sort through the data. Additional words, such as child, language, and assessment will further limit the search. Exact phrases can be placed in parentheses, as in (autism spectrum disorder), so that results will be limited to those words in that order. Searches can be expanded by using an asterisk after the word, as in child*. Search engines then treat child as a root word and will also search children and childhood. Journal searches may be limited by year and author as well. SLPs should be careful with common acronyms that may have other references. Even ASHA yields results other than the American Speech-Language-Hearing Association. Specific techniques for limiting or expanding searches are usually included in the search engine’s Help section.

Conclusion A functional approach emphasizes nurturant and naturalistic methods (Duchan & Weitzner-Lin, 1987). The nurturant aspect requires an SLP/facilitator to relinquish control to the child and to respond to the child’s communication initiations. The naturalistic aspect emphasizes everyday events and context because language makes sense only when used within a communication context. The SLP becomes a master in the manipulation of that context in order to facilitate communication and generalization. Language is trained while it is actually used in everyday contexts. As a result, the training generalizes. Learning and generalization are the result of good planning based on a knowledge of the variables that affect generalization and the individual needs of each child. The content selected for training and the context within which this training takes place are both important aspects of the generalization process. The SLP helps the child determine the best response to fulfill his or her initiations within contexts that facilitate his or her intervention targets. Although the role of an SLP within the functional language paradigm changes from primary direct service provider to language facilitator and consultant, the SLP still has primary responsibility for planning and implementing intervention. Some professionals cast a wary eye on implementation of such conversational and communicationbased approaches to language intervention. The fear is that intervention will deteriorate into a “Hey, man, what’s happenin’?” approach, too open-ended to be effective in changing client behavior. Although


Part 1 Introduction

this danger does exist, it is not inherent in functional approaches. As this text progresses, we discuss assessment and training procedures that enable SLPs to maintain a teaching momentum within the more natural context of conversation. It’s productive, fun, and evidence based. In the following chapters, we explore LIs, assessment, and intervention. After a discussion of children with LIs, we discuss the assessment process and the collection and analysis of conversational and narrative data. In the following chapters, an intervention paradigm and various techniques are presented, along with discussion of special applications to the classroom environment and to literacy.



Language Impairments


Part 1 Introduction

What’s wrong, Juan? You seem upset. Took them things. Who did, honey? What? That boy. Which one? Show me. Him. (points) Him took thems. Timmy? Timmy took something? (nods affirmatively) Thems! What? I don’t see anything. Thems, thems things that I build. Oh, Timmy took your Legos? Timmy took your Legos. Obviously, we have a communication breakdown. Juan, at age 8, is unable to communicate the simple concept Timmy took my Legos. Juan has a language impairment. Juan, like many of the children described in this chapter, may have impairments in other areas of development as well. For example, children with mental retardation are going to experience slower maturity in all developmental areas, not just language. It is also reported that some children with LI have nonverbal deficits in identifying an object after it has been rotated, in analogies (A is to B as C is to _____), and in rapidly repetitive manual motor tasks (Swisher, Plante, & Lowell, 1994). This and other reported differences may reflect actual deficits or may be confounded by the linguistic aspects of these tasks (Casby, 1997). We still have much to learn from these children. In this chapter, we’ll discuss the most common diagnostic categories of children with LI. I attempt to personalize this discussion whenever possible, but readers should remember that we are examining groups of children, not individuals. For example, no one child with a language learning disability may exhibit all of the characteristics ascribed to these children. I’ll try to explain commonalities and differences across various disorders and to explore the most common language problems seen by SLPs.

Diagnostic Categories Many categories of disability have language components. In this section, we discuss some of these categories in detail, attempting to describe both similarities and differences. Typical language learning requires the following (Johnston, 1991): 1. 2. 3. 4. 5.

The ability to perceive sequenced acoustic events of short duration The ability to attend actively, to be responsive, and to anticipate stimuli The ability to use symbols The ability to invent syntax from the language of the environment Enough mental energy to do all of the above simultaneously

Because language is learned naturally from another person in the course of conversation, let’s add an additional requirement: 6. The ability to interact and communicate with others

Chapter 2

Language Impairments


Many of the children described in the following section have problems in one or more of these areas. As we discuss each language impairment, try to keep these abilities in mind. There is a danger in describing categories of children and then assigning children to these categories. In general, such categories are helpful for discussion, but there is a danger that the category can become self-fulfilling. Children assigned to the category then are treated as the category, not as individuals. It is important to remember that the child is not mentally retarded, but rather is a child with mental retardation. Discussing of LI categories can also cause us to overlook the similarities that exist between children classified by different categories. Many assessment and intervention strategies and techniques can be used across children. Many children with LI cannot be described easily by any of the categories discussed in this chapter. Such children may have either more than one primary diagnostic category or characteristics that do not fit into any category. Each child represents a unique set of circumstances, so language assessment and intervention should be individualized. Within each disorder category below, we will limit the discussion to general characteristics, language characteristics, and possible causal factors. Although causal influences vary widely, studies of twins suggest a strong genetic component for many language impairments, especially more severe deficits (DeThorne, Petrill, Hayiou-Thomas, & Plomin, 2005; Segebart DeThorne, Hart, Petrill, DeaterDeckard, Thompson, et al., 2006). Perception and learning style also are important, as is environmental input. For example, while typically developing children use one aspect of language to facilitate learning another, such as using semantic knowledge to aid syntactic learning, in a process called bootstrapping, children with LI, especially late-talkers, may have different learning styles and use these learning strategies less frequently and/or less effectively (Jones Moyle, Ellis Weismer, Evans, & Lindstrom, 2007). In general, mothers of children diagnosed with LI initially at age 3 and then again at age 41⁄2 are less sensitive and exhibit more depression than mothers of children whose LI had been resolved by this time (La Paro, Justice, Skibbe, & Planta 2004). Measures of maternal sensitivity include to what degree a mother is a supportive presence, respects her child’s autonomy, and expresses hostility. This suggests the importance of a mother–child relationship in the language growth of preschool children with LI. Any discussion of LI may miss these subtle differences and their affect on a child with LI. Disorders and delays do not solely reside in the child. Unfortunately, we will be unable to discuss all possible language impairments. Some identifiable disorders have been omitted because of the small numbers of children or the paucity of research data. Others—for example, Tourette syndrome, a neurological movement disorder that affects up to 3 percent of children and consists of uncontrolled motor and phonic tics (Jankovic, 2001)—have been omitted because concomitant behaviors place the disorder in a somewhat specialized category and because language impairment is tangential to the primary disorder. In addition, language impairments resulting from low birth weight, prolonged hospitalization, or multiple births are not discussed separately and can be found within other categories described in this chapter (Bishop & Bishop, 1998; Hemphill, Uccelli, Winner, Chang, & Bellinger, 2002; Tomblin & Buckwalter, 1998). Finally, deafness has also been omitted because of the very broad range of issues relative to hearing, speech, and language. Issues of deafness deserve their own text. At the end of the chapter, I’ll make a few brief remarks on some of the categories of LI that have been omitted from the more detailed explanations to follow.


Part 1 Introduction

I N FOR MATION PROCESSI NG Prior to discussing specific disorders, it may be helpful to quickly review the information processing system that serves both thought and language. New research is indicating the importance for both language development and language impairment of this system and of the processing of information. Each individual processes information in a somewhat different manner. These differences can be explained by structural differences in individual brains and by learned differences, such as the way in which each of us approaches new information or problem solving. These learned differences influence, among other things, decisions about attending, schemes for organization, and rules and strategies for handling information. Information processing can be divided into four steps: attention, discrimination, organization, and memory or retrieval. These are presented in Figure 2.1. Attention includes automatic activation of the brain, orientation that focuses awareness, and focus (Cowan, 1995). When the brain focuses on a stimulus, a neural or mental “model” is formed in working memory that allows further processing to occur. We do not attend to all possible stimuli, as can be noted in Stimulus D in Figure 2.1. A child with poor attending skills may not pay attention to important stimuli, with the result that he or she will have poor discrimination. In order to discriminate both likenesses and dissimilarity we need to observe or attend for short periods. Discrimination is the ability to identify stimuli from a field of competing stimuli. Decisions are made on the similarity or dissimilarity of stimuli based on the “model” in working memory. In Figure 2.1, Stimuli B and C are perceived to be similar to each other and to information previously stored in Area 2, a fictitious location in the brain. Incoming linguistic information undergoes two types of synthesis: simultaneous and successive. Simultaneous coding is related to higher thought, and separate elements of the message are synthesized into groups so that all members are retrieved simultaneously. Overall meaning of the message is coded.

Executive Function Near transfer Long-term memory

Working memory A S B T I C M U L D I E F

A t t e n t i o n

D i s c r i m i n a t i o n

New problem


Needs immediate response New problem

O r g a n i z a t i o n



4 5 6

Far transfer


Schematic representation of information processing.

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Language Impairments


In contrast, successive coding occurs in linear fashion, one at a time. Language is processed at the unit level rather than holistically. Both processes are used for decoding and encoding of linguistic and nonlinguistic information. Organization is the categorization of information for storage and later retrieval. Information that is organized is more easily retrievable. Material that is unorganized or poorly organized will hinder later recall and quickly overload memory capacity. More efficient processing requires increasingly better organization, which, in turn, leaves room for more information. In this fashion, capacity for long-term storage becomes virtually unlimited. It would be erroneous to think of storage as simply filing of information. Information is stored in networks that relate to all aspects of stored information. The more associations formed, the better memory and retrieval function. Memory is the retrieval of information. The capacity for storage and the speed and accuracy of retrieval increases with maturity. Retrieval is limited and dependent on environmental cues, the frequency of previous retrieval, competition from other memory items, and the age of learned information. All else being equal, it is easiest to retrieve information that has been frequently retrieved, has few competing memory items, has distinct environmental cues, and was learned recently and well. Although not one of the four steps, transfer, or generalization—the application of learned material to previously unlearned information or to new contexts—is important for learning. Transfer exists along a continuum of near to far. Near transfer involves only minimal difference between known information and the new problem. In contrast, far transfer involves substantial difference. Both types are represented in Figure 2.1. As you might assume, near transfer is easier for people functioning typically. The simplicity of this discussion doesn’t do justice to this complex process. Actually, processing occurs on many levels simultaneously (Snyder, Dabasinskas, & O’Connor, 2002). At bottom levels, processing is shallow and involves primarily perceptual analysis. In contrast, top levels of processing are more elaborate and associate the new information with knowledge already storied in the brain. As you might surmise, top processing results in better memory because of the associations formed (Hamman & Squire, 1996, 1997). Less complex stimuli are initially processed via perceptual analysis at bottom levels then forwarded to working memory for more elaborate encoding—a process called bottom-up processing—and storage in long-term memory. For more elaborate stimuli, such as language, the brain activates higher, or top-level, processes, such as linguistic and word knowledge. Through these processes, the brain formulates “guesses” of what’s coming next, and the low-level processes analyze incoming information perceptually to see how it fits. This process is called top-down. In other words, language is “heard” in accordance with the guesses that are based on stored linguistic information and the message so far (Samuel, 2001). It’s unknown whether the two processes are dependent, interdependent, independent, or if they function simultaneously (Von Berger, Wulfeck, Bates, & Fink, 1996). In addition, the processes may operate either automatically or in a controlled fashion based on the amount and type of information incoming, the demands of the task, and the capacity of the individual. In contrast to automatic processes, controlled ones are performed consciously and intentionally and make considerable demands on the resources of the brain. It’s believed that working memory is the “place” where information is kept active through a system of coding, storage, access, and retrieval (Gillam & Bedore, 2000). Working memory is the place where information, such as an incoming or outgoing sentence, is held while it is processed. While encoding and decoding, working memory must have enough capacity to handle complex information but be flexible to keep up with changing input.


Part 1 Introduction

The brain’s central executive function (CEF) determines the cognitive resources needed and monitors and evaluates their application while controlling the flow of information. Thus, the CEF is responsible for selective attention and for the coordination and inhibition of stimuli and concepts (Baddeley, 1996). Children with LI may exhibit difficulty with CEF in the ways in which they attend to and perceive information and the ways in which concepts are represented (Gillam, Hoffman, Marler, & WynnDancy, 2002). Now let’s pull this all together. And this is important. If a child must use controlled processes in bottom-level analyses, he or she may be limiting the amount of language processed. In other words, the child may not have the resources available for automatic top-level analysis (Ellis Weismer, 1994; Ellis Weismer & Hesketh, 1996; Johnston, 1995). Too much energy expended in bottom-level controlled analysis—because of poor attending, poor working memory, poor discrimination, or poor organization and/or retrieval—may limit the child’s ability to process language automatically at higher levels of functioning. As we discuss information processing in each disorder, remember the overall process and the effects that each step in the process has on the others. For a more detailed discussion see Owens (2008). M E NTAL R ETAR DATION OR I NTE LLECTUAL DISAB I LITY The American Association on Intellectual and Developmental Disabilities (AAIDD) defines intellectual disability (ID) as the following: limitations in intrllrctual functioning; • Substantial Significantly limitations in adaptive behavior consisting of conceptual, social, and practical skills; • and • Originating before age 18 (AAIDD, 2008) This definition needs some explanation. Significant limitations means two standard deviations below the mean of 100, a position at the extreme of the human intelligence curve. Approximately 3 percent of the population is below this point, which is at an IQ of 68. The definition is concerned with more than IQ, which is a measure of past learning, and considers intellectual functioning plus adaptive areas. Finally, individuals with mental retardation are considered to be developmental beings, so the definition covers the period during which humans develop into adults. Only individuals who meet all of the criteria are considered to have intellectual disabilities. The exact number of individuals who have intellectual disability is unknown. Estimates vary from 1 to 3 percent of the population, or approximately 3 to 9 million people in the United States. Severity varies among individuals and usually changes little over time. Severity typically is associated with IQ, as noted in Table 2.1. Nearly 90 percent of the population with ID is classified as mildly retarded. Not every child with ID is similar. Differences in severity occur, and other factors, such as amount of home support, living environment, education, type of retardation, mode of communication, and age, must be considered. I have worked with very social, very verbal preschoolers and with adolescents and adults with severe multiple disabilities and very few usable communication behaviors.

Chapter 2

TABLE 2.1 Severity

Language Impairments


Severity of Intellectual Disability IQ Range

% of MR Characteristics




Usually live and work independently within the regular community. Often have families.




Capable of some semi-independence at work and in residence. As adults, many work in supportive environments and live with relatives or in community residences.




Capable of learning some self-care skills and are not totally dependent. Some adults are able to work in a supportive environment and live with relatives or in community residences.


19 and below


Capable of learning some basic living skills but will require continual care and supervision. Often exhibit multiple handicaps.

Source: Adapted from American Association on Mental Retardation (1992).

Language Characteristics Language is often one of the most impaired areas for a child with ID and may be the single most important characteristic of the disorder. Even when compared with typically developing (TD) children of the same mental age, children with ID often exhibit poorer language skills. Although some of this language difference may be attributed to low intellectual functioning, this factor alone does not fully explain the phenomenon. In addition, the cognition–language relationship is an inconsistent one among individuals with ID. For approximately half of the population with ID, both language comprehension and production levels are similar to cognitive levels. In other words, a 6-year-old child with ID might have both a mental age and a language age of 42 months. In 25 percent of the population, both language comprehension and production are below the level of cognition. Finally, in another 25 percent, language comprehension and cognition are at similar levels but language production is below both. Differences between the language of children with ID and those developing typically are presented in Table 2.2. It cannot be stressed enough that children with ID vary greatly in their communication abilities. In general, children with Down syndrome (DS) and those with fragile X syndrome (FXS), both explained later, have moderate to severe delays in communication development in speech and in all areas of language (Roberts, Mirrett, & Burchinal, 2001). Some children with FXS also exhibit behaviors associated with autism spectrum disorder (ASD), discussed later in this chapter. These children tend to have more severe language impairment than those without ASD (Philofsky, Hepburn, Hayes, Hagerman, & Rogers, 2004). Boys with FXS perform differently in conversation than boys with Down syndrome. Although both groups make more noncontingent, or off-topic, responses than typically developing (TD) boys, those with FXS use more perseverative or overly repetitious speech (Roberts, Martin, Maskowitz, Harris, Foreman, et al., 2007). In phonology, boys with FXS make errors similar to those of younger typically developing youth, while those with Down syndrome have more significant phonological differences than might be expected by delayed development alone (Roberts, Long, Malkin, Barnes, Skinner, et al., 2005). Prior to a mental age of 10, the overall sequence of development of children with ID is similar to that of TD children, but the rate is slower (Pruess, Vadasy, & Fewell, 1987). This pattern can be seen in


Part 1 Introduction


Language Characteristics of Children with Intellectual Disability


Gestural and intentional developmental patterns similar to those of children developing normally. Delayed gestural requesting. May take less dominant conversational role. No difference in clarification skills from mental-age-matched peers developing typically.


More concrete word meanings. Slow vocabulary growth. More limited use of a variety of semantic units. Children with Down syndrome able to learn word meanings from exposure in context as well as mental-age-matched peers developing typically.


Length-complexity relationship similar to that of preschoolers developing typically. Same sequence of general sentence development as children developing typically. Shorter, less complex sentences with fewer subject elaborations or relative clauses than mental-age-matched peers developing typically. Sentence word order takes precedence over word relationships. Reliance on less mature forms, though capable of more advanced. Same order of morpheme development as preschoolers developing typically.


Phonological rules similar to those of preschoolers developing typically but reliance on less mature forms, though capable of more advanced ones.


Poorer receptive language skills, especially children with Down syndrome, than mental-age-matched peers developing typically. Poorer sentence recall than mental-age-matched peers. More reliance on context to extract meaning.

Source: Based on Abbeduto, Davies, Solesby, & Furman (1991); Abbeduto, Short-Meyerson, Benson, & Dolish (1997); Chapman, Kay-Raining Bird, & Schwartz (1990); Chapman, Schwartz, & Kay-Raining Bird (1988); Kernan (1990); Klink, Gerstman, Raphael, Schlanger, & Newsome (1986); Merrill & Bilsky (1990); Mervis (1988); Moran, Money, & Leonard (1984); Mundy, Kasari, Sigman, & Ruskin (1995); Owens & MacDonald (1982); Rondal, Ghiotto, Bredart, & Bachelet (1988); Rosin, Swift, Bless, & Vetter (1988); Shriberg & Widder (1990).

development of intentions, role taking, presupposition, sentence forms, morphological markers, and phonological processes (Mundy, Kasari, Sigman, & Ruskin, 1995; Owens & MacDonald, 1982; Shriberg & Widder, 1990). Presupposition is the speaker’s assumption of the listener’s perspective, what she or he knows and needs to know. This said, children with Down syndrome, a chromosomal disorder, are also as skilled as their mental-age-matched TD peers in inferring novel word meanings and in producing these words correctly thereafter (Chapman, Kay-Raining Bird, & Schwartz, 1990). Even when children are matched for mental age, however, children with ID seem to use more immature forms than do their TD peers. The utterances of children with MR tend to be shorter and less complex. Although the narratives of children and adults with Down syndrome are of the same length and complexity as those of mental-age-matched TD peers, the linguistic devices and cohesion are poorer (Boudreau & Chapman, 2000). Children with DS produce fewer words, fewer different words, and shorter utterances while engaging in more verbal perseveration than mental-age-matched

Chapter 2

Language Impairments


TD peers (Rein & Kernan, 1989). Perseveration is excessive talking on a topic when it is inappropriate or needless repetition. Males with FXS perseverate more than children with Down syndrome and exhibit more jargon, or meaningless unintelligible speech, and more echolalia, or repetition of a partner’s speech. Although children with ID are capable of learning syntactic rules, they tend to rely on less mature word-order rules and a less mature and simpler method of interpretation. Likewise, although capable of requesting clarification when communication breaks down, children with ID are less likely to do so within conversations (Abbeduto, Davies, Solesby, & Furman, 1991). It is possible that the difficulties noted in the language of children with ID reflect problems integrating learning into ongoing events. Possibly these children are using much of their available cognitive energy to monitor and understand the conversation, leaving little for integration of language skills. All of us experience this phenomenon with newly acquired skills until they become more automatic. Finally, some children with ID, especially those with DS, exhibit poorer receptive language skills than do their mental-age-matched TD peers (Abbeduto, Furman, & Davies, 1989; Chapman, Schwartz, & Kay-Raining Bird, 1988; Mervis, 1988; Rosin Swift, Bless, & Vetter, 1988). The context seems particularly important for these children in aiding comprehension (Ezell & Goldstein, 1991). Possible Causal Factors Possible causal factors for ID are many and varied, including, but not limited to, biological and socialenvironmental causes of retardation and information-processing differences related to language comprehension and production (Table 2.3). Any discussion of causality must be tempered with the recognition that for many children the cause of mental retardation is unknown. In addition, more than one causal factor may be at work. In any case, causal factors rarely are related directly to the performance level of the child in question. Biological Factors Biological causes are most likely a factor for a majority of children with ID. These include genetic and chromosomal causes, such as Down syndrome (DS); maternal infections, such as rubella or measles; toxins and chemical agents, causing, for example, fetal alcohol syndrome; nutritional and metabolic causes, such as phenylketonuria, or PKU; gestational disorders, primarily in the formation of the brain or skull; complications from pregnancy and delivery; and gross brain diseases, including tumors. In general, a strong correlation exists between biological factors and severity of retardation. Remember that although biological causal factors may explain resultant retardation in part, they tell us very little about development, specifically language acquisition. Social-Environmental Factors Social-environmental causal factors of retardation are more difficult to identify and may involve many interactive variables. Deprivation, poor housing and diet, poor hygiene, and lack of medical care can affect the development of the child adversely, although the exact effect of each is unknown and varies with each child. Despite the fact that children with ID display only limited behaviors, there is no evidence that their mothers interact with them less. In general, maternal behavior varies with the child’s language level, whether the child has ID or is developing typically. Mothers of children with ID do talk more to their children. By attributing more meaning to their children’s less frequent behaviors, these mothers are able to interact more frequently (Yoder & Feagans, 1988). In short, mothers of children with ID interpret more of their children’s behaviors as communicative than do mothers of children developing typically.


Part 1 Introduction


Causal Factors Related to Intellectual Disability (Adapted from AAMR)


Biologic Genetic and chromosomal



Down syndrome (Trisomy 21) Fragile X syndrome

Broad head and characteristic facial features, small stature, mental retardation Mental retardation in males, possible learning disabilities in females; 4:1 males to females Catlike cry, microcephaly, mental retardation

Cri-du-chat syndrome Infectious processes

Maternal rubella Congenital syphilis

Toxins and chemical agents

Fetal alcohol syndrome Lead poisoning

Nutrition and metabolism

Phenylketonuria (PKU) Tay-Sachs disease Inadequate diet

Gestational disorders


Cardiac defects, cataracts, hearing loss, microcephaly, possible mental retardation Deafness, vision problems, possible epilepsy or cerebral palsy, mental retardation Persistently deficient growth, low brain weight, facial abnormalities, cardiac defects, mental retardation Central nervous system and kidney damage, hyperactivity Reduced pigmentation, motor coordination problems, convulsions, microcephaly, mental retardation Progressive deterioration of nervous system and vision, mental retardation, death in preschool years Small stature, possible mental retardation

Craniofacial anomalies

Enlarged head caused by increased volume of cerebralspinal fluid, visual defects, epilepsy, mental retardation Absence or underdevelopment of cerebral cortex and resultant mental retardation Malformed skull and associated mental retardation

Complications of pregnancy and delivery

Extreme immaturity or preterm infant Exceptionally large baby Maternal nutritional disorders

Low birth weight, higher prevalence of central nervous system disorders Possible birth injury to central nervous system Low birth weight, higher prevalence of central nervous system disorders

Gross brain diseases

Tumors and tuberous sclerosis Huntington disease

Tumors in heart, seizures, tuberous “bumps” on nose and cheeks, mental retardation Degenerative neurological functioning evidenced in progressive dementia and cerebral palsy

Cerebral malformation

Social-Environmental Psychosocial disadvantage

Sensory deprivation

Subnormal intellectual Functional retardation functioning in immediate family and/or impoverished environment Maternal deprivation Functional retardation and failure to thrive Prolonged isolation

Source: Owens (1997). Mental retardation. In D. Bernstein & E. Tiegerman-Farber, Language and communication disorders in children (4th ed.). Boston: Allyn & Bacon. Reprinted by permission.

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Mothers of children with ID match their verbal behavior to their child’s language ability while adopting a teaching role (Davis, Stroud, & Green, 1988). Although they exert more control in play than do mothers of children developing typically, mothers of children with DS are equally or more responsive to their children (Tannock, 1988a, 1988b). Their control behavior includes trying to elicit more responses from their children. Processing Factors There may be differences in the cognitive, or information-processing, abilities of the ID population that cannot be attributed to low IQ alone. Children with ID do not seem to process information in the same manner as mental-age-matched TD peers. This difference is especially critical for learning. Cognitive abilities important for learning are attention, discrimination, organization, memory, and transfer. Attention. In general, individuals with ID can sustain attention as well as mental-age-matched TD peers. Difficulty comes for the individual with ID in the scanning and selection of stimuli to which to attend. Persons with severe or profound ID have more limited attentional capacity and are less efficient at attention allocation (Nugent & Mosley, 1987). Discrimination. Individuals with ID have difficulty identifying relevant stimulus cues. This difficulty reflects, in part, the tendency of individuals with ID to attend to fewer dimensions of a task than do TD individuals. If the stimulus dimensions chosen are not the salient or important ones, the individual’s ability to discriminate and to compare new information to stored information is limited. Discrimination can be taught, however, and individuals with ID can apply this information to discrimination tasks as well as can individuals who are nonretarded. In general, discrimination ability and speed are related to severity of ID. The more severe the retardation, the slower and less accurate the discrimination. Organization. Individuals with mild-moderate ID have difficulty developing organizational strategies to aid storage and retrieval. They do not seem to rely on either mediational or associative strategies or to use them as efficiently as individuals developing typically. In mediational strategies, a word or a symbol, such as a category name, forms a link between two entities. In associative strategies, one word or symbol aids in recall of another, as in “bacon and _____” or “salt and _____.” Individuals with mild ID exhibit both simultaneous and successive coding; however, these individuals may use these processes differently from individuals who are nonretarded, especially in complex tasks. Individuals with Down syndrome seem to have greater difficulty with successive processing than do other mental-age-matched individuals with ID. This deficit may be explained in part by the poor verbal auditory working memory abilities of individuals with DS. It is interesting to note, however, that the reported sequential processing difficulties of children with DS do not affect number sequential recall (Kay-Raining Bird & Chapman, 1994). The element of meaning present in language may complicate verbal sequential processing. Memory. In general, individuals with ID demonstrate poorer recall than individuals developing typically. The more severe the retardation, the poorer the memory skills. Individuals with mildmoderate ID are able to retain information within long-term memory as well as TD individuals, but the retrieval process is slower (Merrill, 1985). No doubt, organizational deficits contribute to difficulty retrieving information. More obvious differences can be seen in short-term memory (Gutowski & Chechile, 1987). Poor performance by individuals with mild ID may reflect a limited use of associational strategies and


Part 1 Introduction

organizational/storage deficits. It may be affected also by the rapid rate of forgetting, especially within the first 10 seconds, found in the population with ID (N. Ellis, Deacon, & Wooldridge, 1985). Information is retained by rehearsal. It appears that individuals with ID do not spontaneously rehearse and that they need more time than TD individuals to do so (Turner & Bray, 1985). The need for repeated input and practice retrieval are supported in studies of vocabulary learning among children with Down syndrome (Chapman, Sindberg, Bridge, Gigstead, & Hasketh, 2006). Memory can be affected also by the type of information. Individuals with ID do more poorly with auditory information than with visual (N. Ellis, Woodley-Zanthos, & Dulaney, 1989). Within auditory information, nonlinguistic signals, such as a car horn or a doorbell, are much easier for individuals with ID to remember than linguistic information. In general, nonlinguistic signals can be recognized and recalled similarly by individuals with mild ID and without. It is in the recall of linguistic information that differences become evident. Sentence recall involves reproduction from memory and editing of the recalled text. For individuals with mild ID, difficulty probably is encountered in the second stage. Auditory memory deficits are exhibited more by individuals with DS than by those with other types of retardation (Marcell & Weeks, 1988). Deficits in auditory short-term memory for words is implicated in the poor performance of children with DS in sentence memory tasks (Miolo, Chapman, & Sindberg, 2005). Phonological short-term recall seems to be especially affected (Seung & Chapman, 2000). This difficulty may be related to poor verbal working memory, a process that enables the hearer to continue to hear a sound after it has ceased. The “echo” may decay more rapidly among individuals with DS than among individuals developing typically. The memory deficit among individuals with DS is specific to verbal information and seems unrelated to receptive vocabulary or auditory or speech difficulties (Jarrold, Baddeley, & Phillips, 2002). Transfer. Transfer, or generalization, is an area of processing especially difficult for individuals with ID. Although learning may enhance performance, it does not enhance generalization. In general, the more severe a person’s ID, the weaker that person’s transfer abilities. In addition, persons with ID have difficulty with both near and far transfer, in part because of an inability to detect similarities. Thus, generalization deficits may reflect discrimination and organization problems mentioned previously.

Conclusion Generalizations about the language skills of the population with ID are complicated by the many causes of ID and by different severities. Overall, language development follows a path similar to typical development but at a slower pace. Still, differences occur, such as the reliance on less mature forms and the overuse of others. These differences may reflect the information-processing difference found in individuals with ID, especially in the areas of organization and memory. Problems in information processing help us understand ID and other disorders but do not explain these disorders. Differences may represent the cause, the result, or a concurrent problem (Leonard, 1987). In any case, the differences found in the population with ID suggest certain intervention techniques to be used when working with children with ID. These are represented in Table 2.4. An SLP must be mindful of individual learning styles as well as those of certain identifiable groups of children. For example, accommodations must be made in intervention for the special learning needs of boys with FXS. In short, with these boys, an SLP can take advantage of their more visual learning style while stressing listening and comprehension. Intervention sessions must accommodate to these

Chapter 2


Language Impairments


Techniques to Use with Individuals with Intellectual Disability

Attention 1. Aid attending by visually or auditorily highlighting stimulus cues. Likewise, gestures used to highlight important information can enhance the auditory message. Cues should be gradually decreased. 2. Teach child to scan stimuli for relevant cues. Discrimination 1. Highlight and explain similarities and differences that will aid discrimination. Preschoolers do not understand terms such as same and different. Teachers must demonstrate likenesses and differences, such as hair/no-hair. Meaningful sorting tasks with real objects can be helpful. Overall size and shape (not circle, square, or triangle) and function are relevant characteristics for preschoolers. Organization 1. “Pre-organize” information for easier processing and storage. No “winging it” here. Visual and spatial cues may be helpful. 2. Train associate strategies. What things go together? Why? 3. Use short-term memory tasks, such as repetition of important information, to aid simultaneous and successive processing. Repetition and interpretation are helpful. Memory 1. Train rehearsal strategies, such as physical imitation. Gradually shift to more symbolic rehearsal tasks. 2. Use overlearning and lots of examples. 3. Train both signal (sounds, smells, tastes, sights) and symbol recall of events. Signals, which are easier to recall, can be gradually reduced. 4. Word associations for new words will improve recall of the words. Likewise sentential and narrative associations will improve recall. 5. Highlight important information to be remembered, thus enhancing selective attending. 6. Use visual memory to enhance auditory memory. Transfer 1. Training situations should be very similar or identical to the generalization context. Use real items in training, at least initially. 2. Highlight similarities between situations, especially if training and generalization contexts differ. Help child recall similarities. 3. Help child recall previous tasks when approaching new problems. 4. Use people in child’s everyday contexts for training. Source: Adapted from Owens (1989).

boys’ short attention span, difficulty with transitions to new activities or topics, other sensory deficits, and low tolerance of stress (Mirrett, Roberts, & Price, 2003). Some of these children have nonverbal learning disability (NLD), which is characterized by deficits in visual and tactile perception, psychomotor skills, and learning novel information. Although language form is relatively unaffected in children with NLD, subtle pragmatic and semantic impairments exist.


Part 1 Introduction

LANG UAG E LEAR N I NG DISAB I LITY The National Joint Committee on Learning Disabilities (1991) has adopted the following definition of learning disabilities: Learning disability is a general term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. These disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may occur across the lifespan. Problems in selfregulatory behaviors, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability. Although learning disabilities may occur concomitantly with other handicapping conditions . . . or with extrinsic influences . . . , they are not the result of those conditions or influences. (p. 19) Let’s explore this wordy definition a bit. First, as with other disorders, learning disability (LD) is characterized by heterogeneity. It is also important to note that the cause is presumed to be central nervous system dysfunction, although other conditions also may be present. Thus, the cause of learning difficulties is not environmental, nor is it these other accompanying conditions. Although not stated, it is assumed that children with LD have normal or near-normal intelligence. Most children with learning disabilities will not have all of the characteristics. For example, approximately 15 percent have difficulty with motor learning and coordination. More than 75 percent have difficulty learning and using symbols (Miniutti, 1991). These children are considered by some to have a language learning disability (LLD). The characteristics of children with LD are many and varied. In general, they divide into six categories: motor, attention, perception, symbol, memory, and emotion. Let’s discuss each. Symbol difficulties are discussed under language characteristics. Motor difficulties usually involve hyperactivity, a condition of overactivity in which children seem to be constantly in motion. Approximately 5 percent of all children have hyperactivity, but the condition is nine times as prevalent in boys as in girls (Sattler, 1988). Not all children with hyperactivity have learning disabilities, nor do all children with LD have hyperactivity. The condition is difficult to assess, especially among preschoolers, in part because of the wide range of variability (S. Campbell, 1985). Children with hyperactivity have difficulty attending and concentrating for more than very short periods of time. Other motor difficulties of LD may include poor sense of body movement, poorly defined handedness, poor hand-eye coordination, and poorly defined concepts of space and time. Attentional difficulties include a short attention span and inattentiveness. Children with LD seem easily distracted by irrelevant stimuli and easily overstimulated. At present, we are in the middle of an identification frenzy regarding children and adults and their ability to learn and organize their lives. More and more individuals are being labeled with attention deficit hyperactivity disorder, or ADHD, characterized by overactivity and an inability to attend for more than a very short period but without many of the associated difficulties of learning disability. ADHD is most likely an impairment in the executive function of the brain that regulates behavior, especially impulsivity. Although these children have difficulty using language for social and educational purposes, their language deficits are difficult to measure with standardized testing (Oram, Fine, Okamoto, & Tannock, 1999). Although this explosion of identification of kids and adults with ADHD reflects some real differences, it also reflects our rigid one-

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size-fits-all educational system (Wallach & Butler, 1995), sedentary lifestyle, addiction to junk food, and hectic, overworked parents and teachers. Some children with learning disabilities may become fixed on a single task or behavior and repeat it. This fixation, mentioned previously, is called perseveration. Several children with whom I have worked would repeat an utterance over and over, seemingly unaware that they were doing it. Perception and reception are not the same. Learning disability is not a sensory or reception disorder. Perceptual difficulties are interpretational difficulties. These occur after the stimuli are received. As might be assumed, children with learning disabilities may confuse similar sounds and words and similar printed letters and words. In addition, these children may have difficulty in figure-ground perception and in sensory integration. Figure-ground perception involves being able to isolate a stimulus against a background of competing stimuli. For example, figure-ground discrimination would include being able to listen to the teacher while other things are occurring in the classroom. Sensory integration, on the other hand, involves being able to make sense of visual and auditory stimuli occurring at the same time. Each may carry part of the message. For example, gestures, facial expression, body language, intonation, and verbal language may be used to convey information. Each alone may be insufficient. Memory difficulties include short-term and long-term storage and retrieval. Children with LD often have difficulty remembering directions, names, and sequences. Word-finding problems are also common. Finally, emotional problems also may accompany LD but are not a causal factor. Rather, emotional problems are a reaction to or an accompaniment to the frustrating situation in which these children find themselves. Children with LD have been described as aggressive, impulsive, unpredictable, withdrawn, and impatient. Some children may exercise poor judgment, have unusual fears, and/or adjust poorly to change. I worked with a child with learning disabilities who was afraid of shoes, a rather unusual fear. In others, poor adjustment to change may reflect dependence on routines when one has difficulty interpreting language in those contexts. Language Characteristics Usually all aspects of language, spoken and written, are affected to some extent in children with learning disabilities (Wallach & Butler, 1995). It should be stressed again that although these children may play the TV or radio at a loud volume, or seem to talk too loudly, or squint and rub their eyes when reading, the problem is not sensory. Although hearing or vision difficulties may or may not be present, they are not central to the disorder. Difficulties are perceptual. Children with LD may have difficulty with the give-and-take of conversation and with the form and content of language (Table 2.5). Synthesizing of language rules seems to be particularly difficult, resulting in delays in morphological rule acquisition and in the development of syntactic complexity. Problems with morphological markers are found both in speaking and writing, with the most common error being omission (Windsor, Scott, & Street, 2000). Overall oral language development for children with LD may be slow (Reed, 1986). Their language is often like that of younger children, although children with LD may use mature structures less frequently. As preschoolers, these children may exhibit little interest in language and may be unable to follow a story or be disinterested in books. Word finding is a particular problem found in both conversations and narratives (German, 1987), resulting in greater time needed to respond verbally. Retrieval difficulties may result in more


Part 1 Introduction


Language Characteristics of Children with Learning Disability


Little problem with turn taking. Difficulty answering questions or requesting clarification. Difficulty initiating or maintaining a conversation.


Relational term difficulty (comparative, spatial, temporal). Figurative language and dual definition problems. Word-finding and definitional problems. Conjunction (and, but, so, because, etc.) confusion.


Difficulty with negative and passive constructions, relative clauses, contractions, and adjectival forms. Difficulty with verb tense markers, possession, and pronouns. Able to repeat sentences but often in reduced form, indicating difficulty learning different sentence forms. Article (a, an, the) confusion.


Inconsistent sound production, especially as complexity increases.


Wh- question confusion. Receptive vocabulary similar to that of chronological-age-matched peers developing normally. Poor strategies for-interacting with printed information. Confusion of letters that look similar and words that sound similar.

Source: Based on Baker, Ceci, & Hermann (1987); Catts (1986); Kail & Leonard (1986); Lieberman, Meskill, Chatillon, & Schupack (1985); Seidenberg & Bernstein (1986); Wiig & Wilson (1994).

communication breakdown (MacLachlan & Chapman, 1988), characterized by repetitions, especially of pronouns before words seemingly difficult to retrieve (“He, he, he . . . John was . . .”), reformulations, substitutions of indefinite pronouns (it), empty words (one, thing), delays, and insertions (“He was . . . oh, I can’t remember . . .”) (German & Simon, 1991). Word-retrieval difficulties may be complicated by the deficient vocabularies of children with LD (Leonard, 1990; Wiig, 1990). Young children with LD have poor understanding of literal meanings. As these children age, they experience difficulties with multiple and figurative meanings (R. Lee & Kamhi, 1990; Lutzer, 1988; Seidenberg & Bernstein, 1986; Wiig, 1990). The linguistic demands of the classroom are often well above the oral language abilities of these children. The well-documented academic underachievement of children with LD demonstrates the link between language deficits and learning disabilities (Catts & Kamhi, 1986). Oral language skills are the single best indicator of reading and writing success in school. Difficulty with oral language skills among children with LD is evidenced later in written-language problems, called dyslexia. Dyslexia is a specific learning disability characterized by difficulties in fluent and/or accurate word recognition and in spelling most often associated with phonological awareness or sensitivity to and awareness of the sound and syllable structure of words (Lyon, Shaywitz, & Shaywitz, 2003). Oral language difficulties are also present (Gallagher, Frith, & Snowling, 2000). It’s estimated that possibly as many as 80 percent of children with LD have some form of reading problem and that the incidence of dyslexia in the overall population many range from 5 to 17 percent, depending on how the term is defined (Sawyer, 2006). In either case, a significant portion of the population may exhibit some dyslexic

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characteristics. The disorder is found among males at twice the rate as females. Although there’s no generally agreed-upon definition, when we compare children with dyslexia to their TD peers, some common elements appear (Sawyer, 2006): verbal IQ and/or listening comprehension • Comparable Below average word reading • Nonsense or non-real word reading (word attack) below real-word reading • Well below average phonological processing scores • Three distinct types of dyslexia have been described, including a language-based disorder that may affect comprehension and/or speech sound discrimination, a speech/motor disorder that may affect speech sound blending and motor coordination although receptive language is unaffected, and a visuospatial disorder that may affect letter-form discrimination although language is relatively unaffected. The language-based disorder is the most common. Although reading and writing are different, certain underlying processes influence both. For example, often there is no overall organization to the writing of children with LD. In reading, they also fail to understand the underlying organization, thus treating each sentence as separate and unrelated to the whole (Raphael & Englert, 1990; Seidenberg, 1989). The behavior of children with LD also demonstrates the interrelatedness of cognition and language. This relationship can be seen in analogical reasoning skills in which known concepts are used to solve novel problems. In verbal proposition (A is to B as C is to _____), one type of analogical reasoning, language abilities appear to be more important than, but not exclusive of, cognitive abilities (Masterson, Evans, & Aloia, 1993). Children with LD demonstrate difficulty with verbal analogies such as these (Kamhi, Gentry, Mauer, & Gholson, 1990; Nippold, Erskine, & Freed, 1988). Some of the blame for the problems of children with dyslexia must go to English itself. The rate of dyslexia is twice as high in English-speaking countries as in those with less complex languages. Italian and Spanish, for example, have a more one-to-one relationship between letters, or graphemes, and sounds, or phonemes. In English there are over 1,100 ways to combine the graphemes to represent the phonemes. Possible Causal Factors Several causal factors may contribute to LD. Central nervous system dysfunction indicates a strong biological basis, but information processing, especially perception, is also important. Biological Factors Learning disabilities occur more frequently in families with a history of the disorder and following premature or difficult birth. Children with a parent with dyslexia, especially those with a history of late talking, are at a higher risk for language impairment (Lyytinen, Poikkeus, Laakso, Eklund, & Lyytinen, 2001). These facts, along with central nervous system dysfunction, demonstrate a biological link to the disorder. In addition, the use of neurostimulants, such as Ritalin, to enable some children with hyperactivity to concentrate and attend further suggests a biological basis. It has been suggested that a breakdown occurs along the neural pathways that connect the midbrain with the frontal cortex. This is the area of the brain responsible for attention, regulation, and planning (Bass, 1988). These biological factors alone are insufficient to explain the characteristics that accompany learning disability.


Part 1 Introduction

Several studies have attempted to find a biological cause for dyslexia. It is doubtful that there is a single dyslexia gene. More likely is a scenario in which possibly as many as seven chromosomes are involved in various aspects of the disorder (Grigorenko, 2005). Malformations found in the left hemisphere language-processing areas and between these areas and the visual cortex may be related to these genetic changes and to language-processing deficits (summarized in Galaburda, 2005). MRI studies indicate that, when compared to TD children during reading, children with dyslexia exhibited lower activation of the left occipitotemporal region and heightened activation of Wernicke’s area and the frontal lobe areas associated with motor movement, suggesting compensatory use of these areas (Shaywitz & Shaywitz, 2003). Social-Environmental Factors Although our definition of learning disability precluded any environmental causality, certain environmental factors are important. The language and, in turn, interactional difficulties of children with LD certainly will influence a child’s development. Similarly, many of the acting-out behaviors of these children are in response to the very frustrating situations of their lives. Until the disorder is diagnosed, these children are accused of not trying or of being lazy or stupid. Many of the children with whom I have worked had extremely poor self-images. Many were afraid to try anything new; others would do anything for attention and recognition, even if such recognition was negative. The successes or failures that we have as we interact with others have a great influence on our future interactions. Processing Factors Children with LD do not appear to function in a manner appropriate for their intellectual level. They seem unable to use certain strategies or to access certain stored information. Children with LD exercise poor attentional selectivity, concentrating on inappropriate or unimportant stimuli (Levine, 1987). Appropriate and important information may be screened out along with other information. These children have difficulty deciding on the relevant information to which to attend in both oral and written communication. As mentioned previously, discrimination is extremely difficult for children with LD. A child has difficulty deciding on the relevant aspects of a stimulus that make it similar or dissimilar to another. Children with LD do more poorly than mental-age-matched to peers on rule extraction or identification from repeated exposures (Masterson, 1993). Poor discrimination skills may also reflect deficits in working memory (Harris Wright & Newhoff, 2001). Obviously, information that is poorly attended to and poorly discriminated will be poorly organized. These are children for whom the world often does not make sense, especially linguistically. Their storage categories reflect this confusion. Unlike children with ID, who do not organize spontaneously, children with LD do organize information but too inefficiently for later use. Memory is related to storage, or availability, and retrieval, or accessibility—distinct but related processes (Bjork & Bjork, 1992). Growth in word knowledge results in the creation of semantic networks in which words are related and organized. This growth occurs later and more slowly among children with LD (Leonard, 1990; Reed, 1986; Wiig, 1990). One result is less accurate and slower retrieval by children with LD (German, 1984; Wolf, Bally, & Morris, 1986). Effective learners actively process, interpret, and synthesize information by using effective strategies to monitor and organize learning. Children with LD often fail to access or use taskappropriate strategies spontaneously. These problems persist throughout adolescence and into adulthood. Strategies for working with children with LD based on their processing deficits are presented in Table 2.6.

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Techniques to Use with Children with LD

Attention 1. Reduce competing stimuli. Gradually reintroduce these stimuli as child becomes better able to tolerate them. Eventually intervention should move into the classroom with all the competing stimuli. 2. Highlight those aspects of a situation to which the child is to attend. 3. Use visual and physical cues to aid the child in attending to verbal ones. Perception 1. Train initially with nonspeech environmental sounds, then speech sounds. 2. Use visual and physical cues to aid the child in interpreting verbal ones. 3. Use meaning-based tasks in which a sound change changes the meaning. 4. Visual or hand signals may be used to aid intonational interpretation and turn taking. Organization 1. Help child to see underlying relationships. Use categorizational, associational, and word-class sorting tasks. Use “spreading” model so child realizes many possible associations. 2. Use same/different tasks and match to sample. 3. Be alert that the child’s associations may not be the same as adult ones. Try to understand the relationships that may have validity for the child. Memory and Generalization/Transfer 1. Practice serial recall, first visually (locomotive, touch), then auditorily. 2. Control for infrequent words, linguistic complexity, length, intonation, context, and semantic-logical relationship. 3. Use command following. Control for number of elements and steps. 4. Ask questions about things that happened immediately before. Next, ask questions about slightly distant events. Increase the time lapse. Finally, ask questions concerning what was just said. 5. Teach in the location where you want the feature to be recalled.

Similar Impairments: Prenatal Drug and Alcohol Exposure I have decided to place children with fetal alcohol spectrum disorder (FASD) and prenatal drug exposure in the learning disabilities section because of the similarities children with these disorders present in their behavior and in their language. No doubt there will be objections to this placement. When a pregnant woman drinks, the blood alcohol level of her fetus will be the same as her own. Maternal consumption of alcohol during pregnancy results in fetal alcohol spectrum disorder (FASD) for her baby. Disabilities associated with alcohol consumption during pregnancy are approximately 6 in every 1,000 live births (Health Resources and Services Administration [HRSA], 2005). FASD includes but is not limited to alcohol syndrome (FAS), which is characterized by developmental disorders, growth deficien• Fetal cies, and distinct facial characteristics


Part 1 Introduction

neurodevelopmental disorder (ARND), which is characterized by significant • Alcohol-related impairments in several areas of development and distinct facial characteristics Exposure to alcohol in utero damages central nervous system development, leading to deficits in cognitive, behavioral, and socioemotional functioning (Streissguth & O’Malley, 2001). More specifically, these children will experience difficulties in attention, memory, executive function, learning, behavior control, mental health, and academics across their life spans. At birth, infants with FASD have a low birth weight and short length often accompanied by central nervous system dysfunction as evidenced in microcephaly or a small head, hyperactivity, motor problems, attention deficits, and cognitive disabilities. Mean IQs are in the borderline retarded category with a range of 30 to 105. In general, these children are concrete learners with poor problemsolving abilities and difficulty generalizing. They are easily distractable, easily overstimulated, impulsive, and perseverative; they have poor memory, interpersonal skills, and judgment; and they exhibit language problems characterized by delayed development, echolalia, and language production that exceeds comprehension. Intervention suggestions are presented in Table 2.7. As infants, children with FASD are irritable and have weak sucking and delayed development. Language deficits include problems with word order and word meaning and difficulties in the give-and-take of conversational discourse (Coggins, Olswang, Carmichael Olson, & Timler, 2003). Most often children with FASD are diagnosed as having a learning disability or ADHD. The socially competent communicator understands that communicators interact in predictable ways and uses executive function to direct the choice of language and nonverbal behaviors to fit the communication situation. These functions are disrupted in the child with FASD. Children with FASD are limited by the amount of linguistic information they can process and have deficits in concept formation, self-regulation, and response inhibition (Carmichael Olson, Feldman, Streissguth, Sampson, & Bookstein, 1998; Jacobson & Jacobson, 2000; Mattson, Goodman, Caine, Delsi, & Riley, 1999). Eleven to 35 percent of pregnant women ingest one or more illegal drugs. Although the percentages vary with race, ethnicity, age, socioeconomic status, and geographic location, the use of illegal drugs crosses all these boundaries. The effects on an infant vary with the amount and type of drugs, the method of ingestion, and the age of the fetus (C. C. MacDonald, 1992). Crack cocaine is especially destructive, with fetal death twice as common as among other noncocaine drug-dependent mothers and sudden infant death syndrome (SIDS) three times as high. Crack cocaine, a rapid-acting cerebrocortical stimulant, easily crosses the placental barrier, decreasing placental blood flow and fetal TABLE 2.7

Intervention Strategies for Children with Fetal Alcohol Syndrome

Remove erroneous stimulation. Provide preferential seating. Use picture cues to strengthen verbal instructions. Take care to describe and explain carefully and ask the child to repeat. Use eye contact or the child’s name prior to giving verbal instructions or directions. “Hook” the child’s attention with novel object, topics, and attention getters. Be patient. Challenge the child but remember that he or she may be easily frustrated. Set definite behavioral limits. Provide a tolerant and patient “buddy” to help the child with social interactions.

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oxygen supply, reaching significant blood levels in the fetus, and altering the fetus’s neurochemical functioning. Like infants with FAS, those exposed to crack cocaine also exhibit low birth weight and small head circumference; they are jittery and irritable and spend the majority of their time sleeping or crying. An infant may still be unable to reach an alert state by one month of age (Lesar, 1992). Infants exposed to drugs also have hypertonia, rapid respiration, and feeding difficulties (Weston, Ivins, Zuckerman, Jones, & Lopez, 1989). Easily overstimulated, these hypersensitive infants actively avoid the human face, which, because of its complexity, may overload them cognitively (Griffith, 1988). As might be expected, typical mother–child bonding is disrupted, with resultant delays in motor, social, and language development (Crites, Fischer, McNeish-Stengel, & Siegel, 1992). For her part, an addicted mother’s primary commitment is to drugs, and she may fail to attend to her child. A cycle of infant passivity and parental rejection may be established. The language characteristics of children exposed to drugs begin with few infant vocalizations, inappropriate use of gestures, and a lack of oral language. By preschool, these children are exhibiting word retrieval problems, short disorganized sentences, poor eye contact, turn-taking difficulties, few novel utterances, and inappropriate or off-topic responses (Mentis & Lundgren, 1995). In kindergarten, the child uses short, simple sentences and has a limited vocabulary, especially for abstract terms, multiple word meanings, and temporal/spatial terms. School-age years are characterized by problems with word retrieval and word order and by pragmatically inappropriate language (Rivers & Hedrick, 1992). Children with drug exposure are usually diagnosed as having a learning disability or ADHD. Conclusion LD is an extremely complex concept. Although it is relatively easy to describe the outward behaviors of children with LD, it is very difficult to explain the underlying processes. In short, biological or neurostructural differences and functional neuroprocessing differences in children with LD affect their ability to attend to, discriminate, and remember linguistic and other stimuli, resulting in language that may be impaired in all aspects and in all modes of transmission and reception. At this point, before I confuse you any more, it might be helpful for you to stop and jot a few notes contrasting intellectual disability with learning disability. As we proceed, you can add to your list. SPECI FIC LANG UAG E I M PAI R M E NT Specific language impairment (SLI) can be characterized as “significant limitations in language functioning that cannot be attributed to deficits in hearing, oral structure and function, or general intelligence” (Leonard, 1987, p. 1). In other words, this category of language impairment has no obvious cause and seems not to affect or be affected by anatomical, physical, or intellectual problems. Unlike some children with ID, but similar to most with LD, children with SLI exhibit language performance scores significantly lower than their intellectual performance scores on nonverbal tasks. Children with SLI do not exhibit the perceptual difficulties seen in LD nor the intellectual deficits of ID. SLI is characterized more by the exclusion of other disorders than on some readily identifiable trait or behavior (Leonard, 1991). Clinical identification is difficult and is usually based on the absence of other contributing factors. Even with a paucity of criteria for characterizing children with SLI, we can make certain definitive statements. Children with SLI may appear to be delayed in one aspect of language, although the language problem is not the result of delay, and children with SLI will not catch up to other children


Part 1 Introduction

their age without intervention (Leonard, 1991). Even in their apparent delay, children with SLI are unlike children developing typically at any stage of development (Johnston, 1988b; Leonard, 1991). The usual criteria for SLI are a nonverbal or performance IQ above 85 and a low verbal IQ. For most, expressive abilities are significantly below receptive (Kamhi, 1998). Although children with SLI have typical nonverbal intelligence, they do exhibit deficits in a variety of nonverbal tasks, suggesting impaired or delayed cognitive functioning, such as manipulating mental images, hypothesis testing, haptic or touch recognition, and conservation, or knowing that quantity remains constant across changes unless quantity is added to or subtracted from (Mainela-Arnold, Evans, & Alibali, 2006). Conservation skills are closely related to language skills and verbal working memory for young schoolaged children. These same children have age-appropriate visuospatial short-term and working memory, a right hemisphere function (Archibald & Gathercole, 2006b). An auditory processing disorder in verbal working memory may be evident and will be discussed later (Friel-Patti, 1999; Montgomery, 2002b). As many as 10 to 15 percent of all children may be “late bloomers” who do not achieve fifty single words and two-word utterances by 24 months of age (Rescorla, 1989). Although most of these children seemingly “outgrow” their delay, approximately 20 to 50 percent have language problems that persist into preschool and school age (Paul, 1989a, 1996; Rescorla, 1990; Thal, 1989). These children form the core of those with SLI. As many as 7.4 percent of all kindergarten children may have SLI (Tomblin, Records, Buckwalter, Zhang, Smith, & O’Brien, 1997). Although SLI is a changeable condition with maturity, two-thirds of kindergartners with the impairment will still have difficulty with language as adolescents (Stothard, Snowling, Dishop, Chipchase, & Kaplan, 1998). For example, at age 14, children with SLI still exhibit slower response times in language tasks than do children developing typically (Miller, Leonard, Kail, Zhang, Tomblin, et al., 2006). Even those with more typical language had lingering problems with phonological problems and literacy skills. In general, children with SLI are perceived more negatively by both teachers and peers (Segebart DeThorne & Watkins, 2001). Young children may have behavior problems; however, these decrease with age (Redmond & Rice, 2002). In elementary school, children with SLI take minor roles in cooperative learning, contribute little, and have fewer high-level negotiating strategies than their language-abilitymatched peers developing typically (Brinton, Fujiki, & Higbee, 1998; Brinton, Fujiki, & McKee, 1998). By late elementary school or middle school, language problems take their toll on self-esteem, and these children perceive themselves negatively in scholastic competence, social acceptance, and behavior conduct (Jerome, Fujiki, Brinton, & James, 2002). Language Characteristics As with other language impairments, significant language differences are seen across children with SLI. The language impairment may be primarily, but not exclusively, expressive or receptive, or a combination of the two, and affect different aspects of language, although language form seems to be affected more than other aspects (Aram, 1991; N. Nelson, 1993). In addition, the disorder changes within an individual child as he or she matures. Language difficulties of children with SLI extend across early language skills important for reading decoding and comprehension (Boudreau & Hedberg, 1999). Errors seen in speech may also be present in writing (Gillam & Johnston, 1992). In general, children with SLI have difficulty (a) learning language rules, (b) registering different contexts for language, and (c) constructing word-referent associations for lexical growth (Connell & Stone, 1994; Ellis Weismer, 1991; Kiernan, Snow, Swisher, & Vance, 1997; Leonard, 1987). The result is

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difficulty in morphological and phonological rule learning and application and in vocabulary development (Bishop & Adams, 1992; Ellis Weismer, 1991; Rice, Buhr, & Oetting, 1992; van der Lely & Harris, 1990). Morphologic learning is more closely tied to overall language learning than other aspects of language (Dale & Cole, 1991). Pragmatic problems result from inability to use effective forms to accomplish language intentions. Specific language problems are listed in Table 2.8. TABLE 2.8

Language Characteristics of Children with Specific Language Impairment


May act like younger children developing typically. Less flexibility in their language when tailoring the message to the listener or repairing communication breakdowns. Same pragmatic functions as chronological-age-matched peers developing typically, but expressed differently and less effectively. Less effective than chronological-age-matched peers in securing a conversational turn. Those with receptive difficulties most affected. Inappropriate responses to topic. Narratives less complete and more confusing than those of reading-abilitymatched peers developing typically.


First words and subsequent vocabulary development occurs at a slower rate, with occasional lexical errors seen in younger children developing typically. Poor fast-mapping of novel words. Naming difficulties may reflect less rich and less elaborate semantic storage than actual retrieval difficulties. Long-term memory storage problems are probable.


Co-occurrence of more mature and less mature forms. Similar developmental order to that seen in children developing typically. Fewer morphemes, especially verb endings, auxiliary verbs, and function words (articles, prepositions) than younger MLU-matched peers. Learning related to grammatical function as in children developing typically. Tend to make pronoun errors, as do younger MLU-matched peers, but tend to overuse one form rather than making random errors.


Phonological processes similar to those of younger children developing typically, but in different patterns, i.e., occurring in units of varying word length rather than in one- or two-word utterances. As toddlers, vocalize less and have less varied and less mature syllable structures than age-matched peers developing typically. Poor nonword repetition.


Poor discrimination of units of short duration (bound morphemes). Ineffective sentence comprehension. Reading miscues often unrelated to text graphophonemically, syntactically, semantically, or pragmatically.

Source: Based on Beastrom & Rice (1986); Bliss (1989); Brinton, Fujiki, Winkler, & Loeb (1986); Craig & Evans (1993); Craig & Washington (1993); Ellis Weismer & Hasketh (1996); Ellis Weismer et al. (2000); Gillam & Carlile (1997); Kail & Leonard (1986); Leonard (1986, 1989); Leonard, McGregor, & Allen (1992); Liles (1985a, b); Loeb & Leonard (1988); Merritt & Liles (1987); Montgomery (2000a, b); Newman & McGregor (2006); Rescorla & Ratner (1996); Rice & Oetting (1993); Rice, Oetting, Marquis, Bode, & Pae (1994); Rice & Wexler (1996); Watkins & Rice (1989).


Part 1 Introduction

As might be expected, given the auditory processing problems of children with SLI, morphological inflections are especially difficult (Dale & Cole, 1991; Leonard, McGregor, & Allen, 1992). Morphemes are small units of language that receive little stress in speech. Verb endings and auxiliary verbs pose a particular problem, as does use of pronouns (Frome Loeb & Leonard, 1991; Oetting & Morohov, 1997). The two problems are related because pronoun selection (he versus they) determines some verb endings (walks versus walk) (Connell, 1986a). Verb morphology is a particular difficulty for young children with SLI. Auxiliary verbs, infinitives, verb endings, and irregular verbs offer persistent problems for both preschool and school-age children (Goffman & Leonard, 2000; Redmond & Rice, 2001). Although most tense markers are mastered at age 4 for children developing typically, children with SLI take an additional three years to achieve the same level of competence (Rice, Wexler, & Hershberger, 1998). Morpheme use is not a simple case of all or none. Children with SLI use the regular past tense –ed less when temporal adverbs, such as tomorrow and already, are present in the sentence, suggesting that other sentence elements also play a part in use of the tense marker (Krantz & Leonard, 2007). The relatively late appearance of tense markers, such as part tense –ed, may be an early indication of SLI (Hadley & Short, 2005). Morphological problems found in English have also been reported for children with SLI learning Spanish and modern Hebrew as a native language (Bedore & Leonard, 2001; Dromi, Leonard, Adam, & Zadunaisky-Ehrlich, 1999). The conversational behaviors of children with SLI compared with those of mental-age-matched peers developing typically are marked by both qualitative and quantitative differences (Craig, 1993). Qualitative differences, such as difficulty initiating interaction and inappropriate responses, lead to increased interruptions by other children and other quantitative changes. The child with SLI is less likely to interact with other children over time as the child experiences repeated failure. As a result, children with SLI often are ignored by other children in the classroom and experience reduced interactional opportunities. Thus, children with SLI have poorer social skills and fewer peer relationships and report less satisfaction with these relationships than age-matched classmates (Fujiki, Brinton, & Todd, 1996). In short, children with SLI have deficits in their ability to recognize the impact of and to express emotions when compared to typically developing age-matched peers (Brinton, Spackman, Fujiki, & Ricks, 2007). Both semantic and phonological deficits contribute to word-learning difficulties in children with SLI (Gray, 2004). For example, compared to their TD peers, children with SLI recognize fewer semantic aspects of objects and actions, such as physical features (color, shape, size), thematic elements (throw, hit, catch within a game), and/or causation (who caused an action, who or what received) (Alt, Plante, & Creusere, 2004). Language comprehension and processing are active processes in which the listener infers the meaning from the auditory message, contextual information, and stored world and word knowledge. Children with SLI do not appear to employ actively all of this available information. In general, they have difficulty constructing an integrated representation of a series of events, whether the series is presented verbally or nonverbally (Bishop & Adams, 1992). Thus, vocabulary growth—which occurs typically as the result of inferring meaning from repeated exposure and without direct reference or prompting from adults—will be very difficult for the child with SLI using limited active processing strategies (Rice, Buhr, & Nemeth, 1990; Rice et al., 1992; Weismer & Hesketh, 1996). Compared to TD school-age children, those with SLI, especially those with expressive language deficits, are less successful at initiating play interactions and engage in more individual play and onlooking behaviors (Liiva & Cleave, 2005). Teachers of children with SLI rate their students as exhibiting more

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reticence and solitary-passive withdrawal (Hart, Fujiki, Brinton, & Hart 2004). Reticence is characterized by staring at other children but not reacting, doing nothing even when there are many opportunities, and demonstrating fear of approaching other children. Children exhibiting solitary-passive withdrawal seem to enjoy solitude. Although they play with toys and engage in constructive activity, they do so alone. Reticence and extreme aloneness may lead to rejection by others in middle and high school (Rubin, Burgess, & Coplan, 2002). Children with SLI who have poor social skills are three times as likely to be victimized as their TD peers (Conti-Ramsden & Botting, 2004). In short, poor pragmatic skills are related to poor social outcomes. As a result, by the time they get to junior high, many adolescents with SLI perceive themselves negatively in scholastic competence, social acceptance, and behavioral conduct, characterized by choosing to act in the accepted manner (Jerome et al., 2002). Possible Causal Factors Causes of SLI are difficult to determine and may be as diverse as the children who have the impairment (Johnston, 1991; Tomblin, 1991). With such a diverse population, it is not surprising that several possible causal factors have been identified. Biological Factors The language and learning problems of children with SLI suggest a neurological disorder (Aram & Eisele, 1994). Possible neurological factors include brain asymmetry, in which language functions are located in different areas from those found in the majority of individuals, and delayed myelination, the progressive process of nerve sheathing that results in more rapid transmission of impulses (Galaburda, 1989; Hynd, Marshall, & Gonzalez, 1991; Love & Webb, 1986). The reported adeptness of children with SLI in analyzing visual, spatial patterns is considered by some to be evidence of greater reliance on the right hemisphere of the brain. Language processing, at least linear or sequential processing, is concentrated in the left temporal lobe. Magnetic resonance imaging (MRI) suggests that, compared to TD children, those with SLI exhibit different patterns of brain region activation and coordination that suggest reliance on a less functionally efficient pattern (Ellis Weismer, Plante, Jones, & Tomblin, 2005). These patterns are presented in Figure 2.2. The arrows in this schematic are sized to represent the amount of coordination between brain areas. Note the differences. In addition, those with SLI show reduced activation in the brain areas critical for communication processing (Hugdahl, Gundersen, Brekke, Thomsen, Rimol, et al., 2004). A biological cause is also suggested by a strong familial pattern (Choudhury & Benasich, 2003). Sixty percent of children with SLI have an affected family member, 38 percent an affected parent. The relationship is particularly strong for children with SLI who exhibit expressive language problems (Lahey & Edwards, 1995). When LI occurs in families with a history of SLI, it is often accompanied by reading impairments (Flax, Realpe-Bonilla, Hirsch, Brzustowicz, Bartlett, et al., 2003). Further evidence of a biological factor can be found in preterm births. A sizable minority of infants born at 32 weeks or less are at considerable risk for SLI (Briscoe, Gathercole, & Marlow, 1998). Social-Environmental Factors Although no one has suggested environmental causes, some differences do exist in the interactions of parents with children with SLI and those developing typically (Conti-Ramsden, 1990; Conti-Ramsden, Hutcheson, & Grove, 1995; K. Nelson, Welsh, Camarata, Butkovsky, & Camarata, 1995). Studies have reported conflicting data on the frequency of recast sentences by parents of children with SLI. Sentence recasts, such as expansions, are adult remixes or modifications in a child’s utterance that maintain the focus of the original utterance and can be an effective


Part 1 Introduction

language teaching technique. For example, an adult could expand “Puppy bite” to “Yes, some puppies bite” or recast as “No, that puppy won’t bite.” When parents of children with SLI recast a child’s utterance, they are most likely to recast the noun phrase, in contrast to parents of non-SLI children, who are most likely to recast the verb phrase. This is unfortunate because children with SLI have particular difficulty with the verb phrase (Fey, Krulik, Frome Loeb, Proctor-Williams, 1999). Processing Factors Although children with SLI demonstrate typical nonverbal intelligence, they may also demonstrate cognitive impairments not exhibited on standard intelligence measures (Kamhi, Minor, & Mauer, 1990; Leonard, 1987). As mentioned previously, these children do not seem to employ active processing strategies that use contextual information and stored knowledge. Informationprocessing problems of children with SLI occur with incoming information, in memory, and in problem solving (Ellis Weismer, 1991; L. Nelson, Kamhi, & Apel, 1987). In addition, children with SLI demonstrate slower linguistic and nonlinguistic processing on both expressive and receptive tasks than age-matched children developing typically (Leonard, 1998; C. A. Miller, Kail, Leonard, & Tomblin, 2001; Windsor & Hwang, 1999a). These characteristics suggest limitations in cognitive processing capacity in which tradeoffs exist between accuracy and speed of responding (Ellis Weismer & Evans, 2002). In the rapid give-and-take of conversation this tradeoff results in reduced processing and storage of phonological information, inefficient fast mapping and novel word learning, slow word recognition, and ineffective sentence comprehension (Bishop, North, & Donlan, 1996; Dollaghan & Campbell, 1998; Edwards & Lahey, 1998; Ellis Weismer & Hesketh, 1996; Ellis Weismer, Tomblin, Zhang, Buckwalter, Chynoweth, et al., 2000; C. A. Miller et al., 2001; Montgomery 2000a; Windsor & Hwang, 1999b). Specific difficulty with grammatical markers, such as -ed and plural -s, suggests that the brevity of these morphemes in speech may be a factor. Children with SLI perform considerably below agematched typically developing children in sensitivity to sound contours and sound duration (Corriveau, Posquine, & Goswami, 2007). In addition, these children demonstrate difficulty in nonword (lemprish) repetition. Taken together, these characteristics may indicate underlying language-processing deficits in phonological working memory, where words are held while processed. More specifically, these difficulties may be in the simultaneous processing of analyzing the phonological structure of nonwords and encoding them for production (Marton & Schwartz, 2002). Working memory is an active process that allows for access to a small number of items in conscious awareness. Incoming linguistic knowledge is held in working memory while processed. Limitations in cognitive processing ability and executive function relative to working memory may interact with various modes of input and output to restrict information-processing capacity (Hoffman & Gillam, 2004). The result is linguistic tradeoffs. For example, children with SLI make more production errors as sentences become more complex. The reduced phonological processing capacity of children with SLI may impair their ability to process these grammatical markers (Montgomery & Leonard, 2006). In short, deficits in phonological working memory mean less capacity to store phonological information, accounting for the poor performance of children with SLI on language tasks (Leonard, Ellis Weismer, Miller, Francis, Tomblin, et al., 2007). This situation may be compounded by further deficits in phonological encoding, phonological (sound and syllable) awareness or sensitivity, word knowledge, or a combination of deficits in several areas (Archibald & Gathercole, 2006a; Graf Estes, Evans, & Else-Quest, 2007). That said, it is important to note that children with SLI do not exhibit the phonological awareness difficulties that underlie dyslexia (Catts, Adlof, Hogan, & Ellis Weismer 2005).

Chapter 2


Language Impairments



TD Children

Children with SLI


Neurological processing of TD children and those with SLI. Size of arrows reflects correlational values. Source: Ellis Weismer, Plante, Jones, & Tomblin (2005).

Although poor recall of linguistic units suggests limits in verbal working memory, poor performance on nonlinguistic serial memory tasks suggests that the deficit may not be language specific (Ellis Weismer, Evans, & Hesketh, 1999; Fazio, 1998; Montgomery 2000a, 2000b). In other words, the language performance of children with SLI may be indicative of overall problems in working memory. If the storage and processing demands on working memory exceed the resources available, processing suffers. For example, comprehension of longer, more grammatically complex sentences places considerable strain on the processing abilities of children with SLI, resulting in more comprehension errors (Deevy & Leonard, 2004). With inefficient allocation of mental resources to acoustic-phonetic processing, the child with SLI is easily overwhelmed by rapidly incoming information and cannot effectively employ lexical retrieval, recognition, and integration processes (Montgomery, 2002a). Children with SLI orient more slowly to new information, have more limited capacity for sustained focus, and have greater difficulty refocusing and shifting focus than TD age-matched peers (Gillam, Cowan, & Day, 1995; Marler, 2000; Marler, Champlin, & Gillam, 2001; Riddle, 1992). Lack of attention contributes to inefficiency in forming representations of incoming acoustic information (Helzer, Champlin, & Gillam, 1996; Sussman, 1993). Temporal processing abilities are further slowed by simultaneous multiple linguistic operations. The result of storage/access memory deficits is lower rates of vocabulary learning (Swisher & Snow, 1994). Diminished phonological working memory for words also affects sentence comprehension (Montgomery, 1995). Imagine that you have limited working memory, but communication is occurring at a rapid rate. As the input increases, you are easily overwhelmed, slowing the entire process. Your limited memory makes it increasingly difficult to hold information as more comes in, slowing the process even more.You begin to lose information as more comes in. It’s increasingly difficult to relate new information to partially processed old information. Maybe you’ve experienced this when you’ve tried to communicate in another language. Now you get some inkling of one aspect of language processing for children with SLI.


Part 1 Introduction

Conclusion Much discussion has taken place concerning the viability of SLI as a separate category of language impairment. It has been suggested that SLI is not a distinct disorder category but merely represents children with limited language abilities as the result of genetic and/or environmental factors (Leonard, 1987, 1991; Tomblin, 1991). One recent study of over a thousand preschool children failed to find a qualitatively distinct group corresponding to children with SLI (Dollaghan, 2004). Some educators have suggested that SLI may not even be a useful concept, especially because clinical tools are unable to diagnose it easily and accurately (Aram, Morris, & Hall, 1993). For now, the best diagnostic techniques appear to be rote memory tasks, such as counting or sequential digit recall, nonsense word repetition, rule induction (see description of dynamic assessment of children with LEP, pages 114–115), story recall, grammatical completion, especially verb markers, number of different words in a speech sample, and memory plus interpretation tasks while listening or reading (Fazio, Naremore, & Connell, 1996; Montgomery, 1995; Rice & Wexler, 1996; Watkins, Kelly, Harbors, & Hollis, 1995). Memory and awareness tasks for intervention are presented in Table 2.9. PE RVASIVE DEVE LOPM E NTAL DISOR DE R /AUTISM SPECTR U M DISOR DE R The fourth, revised edition of the American Psychiatric Association’s Diagnostic and Statistical Manual on Mental Disorders (DSM-IV-TR) (2000) lists autism along a continuum labeled pervasive developmental disorder (PDD). Autism spectrum disorder (ASD) is at the more severe extreme, while a milder form of the disorder is called pervasive developmental disorder–not otherwise specified (PDD-NOS) (Bauer, 1995a, 1995b). In actual practice, children are labeled as ASD when the severe form of the disorder exists and as simply PDD or another disorder when the milder form exists. Some children with PDD may be labeled with Asperger’s syndrome or are mislabeled as learning disabled or ADHD. If this is not confusing enough, other children with PDD may be labeled hyperlexic and may exhibit some characteristics of ASD while others with this label appear more like children with learning disabilities. These labels are not assigned arbitrarily but are based on characteristics exhibited by the child. Don’t be too confused by all these labels. We shall try to sort out these differences in the following discussion. The American Psychiatric Association (2000) defines ASD as an impairment in reciprocal social interaction with a severely limited behavior, interest, and activity repertoire. The Autism Society of America further defines ASD as a disorder that has an onset prior to 30 months of age and that consists of disturbances in the following areas: rates and the sequence of motor, social-adaptive, and cognitive skills • Developmental to sensory stimuli—hyper- and hyposensitivity in audition, vision, tactile stimulation, • Responses motor, olfactory, and taste, including self-stimulatory behaviors and language, cognition, and nonverbal communication, including mutism, echolalia, and • Speech difficulty with abstract terms to appropriately relate to people, events, and objects, including lack of social behaviors, • Capacity affection, and appropriate play ASD is found in males four times more frequently than in females (Bauer, 1995a) and affects 1 in 500 children.

Chapter 2

Language Impairments


Within the last few years there has been an explosion in the number of children in the United States diagnosed as PDD. Whether because of better diagnosis or a real increase, 1 in 150 children age 10 and younger are now classified as having some variety of PDD. In real numbers, that equals 300,000 children and over 1 million adults in the United States. As in other language impairments discussed in this chapter, children with ASD are a diverse group. For example, to the best of our ability to measure, slightly more than half of the children with ASD have IQs below 50, with the remainder evenly split between 50–70 and 71 and above (Schreibman, 1988). The best prognostic or recovery indicators are a nonverbal IQ above 70 and meaningful speech by age 5 (Bauer, 1995b). In general, the age of detection of ASD varies with severity and developmental delays, especially in communication and social interaction. The more intense the symptoms, the poorer language and overall development (Pry, Petersen, & Baghdadli, 2005). Although it is rare that the disorder is identified prior to 18 months of age, infants with ASD have been described as either lethargic, preferring solitude and making few demands, or highly irritable, with sleeping problems and screaming and crying (Coleman & Gillberg, 1985). Usually, between 18 and 36 months, the signs become more pronounced, including more frequent tantruming, repetitive movements and ritualistic play, extreme reactions to certain stimuli, lack of pretend and social play, and joint attention and communication difficulties including a lack of gestures. In approximately 20 percent of the cases, parents report typical development until 24 months, especially among girls (Bauer, 1995a). Early identification is often difficult because of the lack of obvious medical problems and the early typical development of motor abilities. Infrequently, onset occurs in later childhood. Recent data suggests that young children with PDD exhibit clusters of impairment in joint or mutual attending, symbolic play, and social affective communication (Wetherby, Prizant, & Hutchinson, 1998). Development often proceeds in spurts and plateaus, rather than smoothly. Most areas of development are affected by delay and disorder, although occasionally one area, such as mechanical or mathematical abilities, is typical or above. I have worked with children well above average in mathematics but unable to dress themselves or to participate in meaningful conversations. Motor behaviors may include toe walking, rocking, spinning, and, in extreme cases, self-injurious behaviors, such as biting, hitting, and head banging. One adolescent with whom I worked was covered with scars and scabs from self-inflicted scratches and bites. Another child pounded his head with his fist an average of more than 7,000 times in a five-hour school day. TABLE 2.9

Intervention for Memory and Awareness with Children with SLI

Naming letters and objects

Repeating novel and nonsense (“funny”) words

Recalling spoken sentences

Rhyming games

Using melody as a memory aid

Recalling of words that begin with specific phonemes

Listening to stories and nursery rhymes

Guessing games based on cumulative cues

Repeating nursery rhymes

Rehearsing verbally

Acting out pictures

Categorizing words and objects

Acting out rhymes Using gestures to aid recall Source: Adapted from Fazio (1996); Montgomery (1995).


Part 1 Introduction

Although it is beyond the scope of this text to discuss intervention for self-injurious behaviors, we should note that they often represent ineffectual ways of communication or stress associated with this lack of communication and can be reduced in some children by providing new more effective ways of communicating (Buschbacher & Fox, 2003). Children with ASD exhibit sensory modulation dysfunction (SMD). Sensory modulation occurs within the central nervous system (CNS) as it attempts to balance excitation and inhibition inputs arising within one’s sensory mechanism with those occurring external to the body. Modulation within the CNS occurs when the electrical properties of neurons change as a result of neurotransmitters or hormones. Typically, sensations are detected and responded to in a routine manner that is appropriate and adaptive (Lane, 2002). SMD is a mismatch between the external demands and a person’s internal system characteristics, resulting in behavior that is underresponsive or overresponsive (Hanft, Miller, & Lane, 2000). For children with ASD, stimuli must be within the limits of a child’s tolerance and expectation. Children with ASD fluctuate between the two extremes, exhibiting overresponsiveness until overload occurs and results in shutdown of the process and a defensive or withdrawal response. Over- and underresponsiveness to stimuli may be found in the same child. For example, loud noises may get no response from a child, while whispering results in a catastrophic response. In general, children with ASD tend to prefer shiny objects, especially those that spin; things that can be twirled; and noises they produce themselves, such as teeth grinding. Children with ASD seem to prefer routines and may become extremely upset with change. Individual children may have very definite preferences in taste, touch, and smell. I worked with one child whose only food preference was dill pickles. Self-stimulatory behaviors may include rocking, spinning, and hand flapping. Relational disorders may be the most distressful aspect of ASD, especially for parents (Bauer, 1995b; Bristol, 1988). In particular, children with ASD often avert their gaze or stare emptily and lack a social smile, responsiveness to sound, and anticipation of the approach of others. Parents often are treated as “things” or, at best, no different from other people. The effect on parents can be imagined. As mentioned, children with a milder form of the disorder are labeled with pervasive developmental disorder–not otherwise specified, PDD-NOS, or simply PDD. Children with PDD-NOS exhibit many of the characteristics of ASD but to a lesser degree. For example, they may have difficulty with social behavior and exhibit poor eye contact and poor use of gestures and facial expressions. Their grammar may be disordered, and they may use echolalia. Compared to children with either ASD or Asperger’s syndrome, ASD children with PDD-NOS have levels of functioning performance (communication, daily living and social skills, IQ, and age of acquisition of language) between the two (Walker, Thompson, Zwaigenbaum, Goldberg, Bryson, et al., 2004). One subgroup of PDD-NOS has significant impairments in social communication but fewer repetitive behaviors than seen in children with ASD. Asperger’s syndrome (AS), a neurodevelopmental disorder less severe than ASD in which cognitive, language, and self-help skills are supposedly not disordered (American Psychiatric Association, 2000), nevertheless is manifested in subtle language impairments with little delay, along with social interaction difficulties, restricted interests, and repetitive behaviors. In general, compared to children with high-functioning autism (HFA), children with AS have high verbal IQ and low nonverbal or performance IQ, while in most children with HFA the pattern is reversed; however, there is considerable overlap between HFA and AS (Ghaziuddin & Mountain-Kimchi, 2004). Communication similarities and differences are presented in Figure 2.3. The heterogeneity of both populations increases the need for thorough evaluation and individualized intervention (Tsatsanis, Foley, & Donehower, 2004).

Chapter 2

Asperger’s Syndrome Difficulties with Verbal learning style No language delay Parallel but little social play Verbose style “Fact gathering” focus Poor intonation and volume


Language Impairments


High Functioning Autism Difficulties with Perceiving and clarifying emotions/intentions of others and regulating self Initiating and maintaining conversations Turn-taking Recognizing and repairing breakdowns Interpreting nonverbal cues

Difficulties with Visual learning style Language delay Delays in both types of play Passive style Visuospatial and mechanical focus Constricted range of intonations



FIGURE 2.3 Similarities and differences in the communication of children with Asperger’s syndrome and high-functioning autism. These characteristics are generalities, and individual children will vary greatly. Source: Adapted from Rubin & Lennon (2004).

Language difficulties with AS include verbosity, a pedantic speaking style, inability to understand the rules of social behavior, including conversation, and an intense interest in a limited range of one or two topics. Children with AS may be poorly organized but perfectionist in their demands, with ability to concentrate deeply and difficulty transitioning. Still other children may be labeled with hyperlexia, a disorder affecting boys and girls at a ratio of 7:1 and characterized by a spontaneous early ability to read—often at age 21⁄2 or 3—but with little comprehension (Aram, 1997). Children with hyperlexia have an intense preoccupation with letters and words and extensive word recognition by age 5 but exhibit language and cognitive disorders in reasoning and in perceiving relationships. In addition to delayed language, these children experience difficulty with connected language in all modalities, especially integrating it with context in order to derive meaning (Snowling & Frith, 1986). As with all the disorders discussed, there is a range of severity. Some children with mild forms may be mislabeled as learning disabled depending on the characteristics present. This is not a science but a fine art. Language Characteristics Communication problems are often one of the first indicators of possible ASD. These may include a failure to begin gesturing or talking, a seeming noninterest in other people, or a lack of verbal responding. Lack of communication skills is one of the most significant stress factors for families of children with ASD and one of the earliest indicators of the disorder. All children with ASD are not alike in development of communication skills. In general, children who say and imitate more words, have better pretend-play skills with objects, and use gestures more often to initiate joint attending, such as pointing at entities to direct attention, have the most rapid expressive vocabulary growth (Smith, Mirenda, & Zaidman-Zait, 2007). Calling attention to entities


Part 1 Introduction

through gestures and sounds seems to be important for comprehension of new vocabulary words (McDuffie, Yoder, & Stone, 2005). The importance of these factors is similar to that found in typical development (Watt, Wetherby, & Shumway, 2006). Poor social interaction and poor language and communication skills are extremely characteristic of children with ASD. Speech does not seem to be difficult for those who speak, although speech is often wooden and robotlike, lacking a musical quality (Schuler & Prizant, 1987). While as many as 25 percent of children with ASD may have typical language (Kjelgaard & TagerFlusberg, 2001), between 25 and 60 percent of the population with ASD remains mute or nonspeaking. Until recently, this lack of speech also has meant that they remained noncommunicating. This situation is changing for some, but not all, children using augmentative and alternative communication (AAC). Those children using speech and language may demonstrate immediate or delayed echolalia, a whole or partial repetition of previous utterances, often with the same intonation. In fact, most children with ASD who learn to talk go through a period of using echolalia (Prizant, Schuler, Wetherby, & Rydell, 1997). Immediate echolalia is variable, increasing in highly directive situations, with unknown words, following an inability to comprehend, in the presence of an adult, in unfamiliar situations, in face-to-face communication with eye contact, and with longer, more complex utterances (Charlop, 1986; Violette & Swisher, 1992). Immediate echolalia also has been found to signal agreement in some children. No such data are available for delayed echolalia. One child with whom I worked would repeat many of the utterances directed to him during the day as he lay in bed prior to sleep. In general, pragmatics and semantics are affected more than language form (Lord, 1988). The give-and-take of conversation seems to be particularly difficult. The range of communication functions is often very limited, and its development is sequential rather than synchronous, as seen in children developing typically. In addition, functions may be expressed in an individualistic or idiosyncratic manner, such as saying “Sesame Street is a production of the Children’s Television Workshop” for “Goodbye.” Children with ASD also seem to have difficulty matching the content and form of language to the context (Swisher & Demetras, 1985). Occasionally, children will incorporate rote utterances, such as the child who says “Attention, K-Mart shoppers” to get attention. Even those individuals who have acquired language often have peculiarities and irregularities in their communication. Specific language characteristics are listed in Table 2.10. Although errors in language form occur in children with ASD, these are not as severe as those for semantics and pragmatics. Syntactic errors that are present seem to represent lack of underlying semantic relationships. Phonological development appears to follow the same sequence as that of children developing typically and not to be delayed inordinately. Possible Causal Factors In the past, children with ASD have been classified as having an emotional-, physical-, environmental-, or health-related impairment. The cause may be any and all of these, although the primary causal factors are probably biological (Schreibman, 1988). Even within this population, neuroanatomical and neurochemical features may differ. Biological Factors Approximately 65 percent of all individuals with ASD have abnormal brain patterns. The incidence of autism accompanying prenatal complications, fragile X syndrome, and Ritt syndrome, a degenerative neurological condition, and among those with a family history of autism

Chapter 2

TABLE 2.10

Language Impairments


Language Characteristics of Children with ASD


Deficits in joint attending. Difficulty initiating and maintaining a conversation, resulting in much shorter conversational episodes. Limited range of communication functions. Difficulty matching form and content to context. May perseverate or introduce inappropriate topics. Immediate and delayed echolalia and routinized utterances. Few gestures used; misinterpretation of complex gestures. Overuse of questions, frequent repetition. Frequent asocial monologues. Difficulty with stylistic variations and speaker-listener roles. Gaze aversion, seeming use of peripheral vision.


Word-retrieval difficulties, especially for visual referents. Underlying meaning not used as a memory aid. More inappropriate answers to questions than age-matched peers.


Morphological difficulties, especially with pronouns and verb endings. Construction of sentences with superficial form, often disregarding underlying meaning. Less complex sentences than mental-age-matched peers developing typically. Overreliance on word order.


Phonology variable within individual child, often disordered. Developmental order similar to children developing typically. Least affected aspect of language.


Impaired comprehension, especially in connected discourse such as conversations.

Source: Based on Alpert & Rogers-Warren (1984); Greenspan & Wieder (1997); Lewy & Dawson (1992); Lord (1988); Lord, Rutter, Goode, Heemsbergen, Jordan, et al. (1989); Rumsey, Rapoport, & Scoery (1985); Swisher & Demetras (1985).

is higher (Schreibman, 1988). In addition, ASD is often accompanied by mental retardation and seizures. All of these suggest a biological basis but do not explain the actual disorder. Other studies have found unusually high levels of serotonin, a neurotransmitter and natural opiate; abnormal development of the cerebellum, the section of the brain that regulates incoming sensations; multifocal disorders of the brain; and impairment of the neural subcortical structures with accompanying impairment in cortical development (Courchesne, 1988; Schopler & Mesibov, 1987; Schreibman, 1988). Recent studies have suggested a genetic link in ASD, although is seems doubtful that a solitary autism gene exists (Wentzel, 2000). It is more likely that several genes are involved and may be shared with other disorders. Social-Environmental Factors Early studies blamed parents for ASD. No basis has been found for this conclusion. In general, parents interact with their children at the appropriate language level.


Part 1 Introduction

Processing Factors Children with ASD have difficulty analyzing and integrating information. When attending, they tend to fixate on one aspect of a complex stimulus, often some irrelevant, minor detail. In other words, responding is very overselective. This fixation, in turn, makes discrimination difficult. Overall processing by these children has been characterized as a “gestalt” in which unanalyzed wholes are stored and later reproduced in identical fashion, as in echolalia. In this relatively inflexible system, input is examined in its entirety rather than analyzed into its component parts. Information usually is reproduced in a context that is in some way similar to the initial context. This reliance on unanalyzed wholes could account for the tendency of children with ASD to repeat an agrammatical sentence, rather than to correct it as language-matched children with ID will do. It is possible that children with ASD depend more heavily on simultaneous language processing than on successive language processing. The behavior of children with ASD suggests that very little of the world makes sense to them. They seem to overload quickly. Information “swallowed” whole could quickly “fill” the system. Storage of unanalyzed wholes also might hinder memory. Children with autism reportedly are less able to use environmental cues to aid memory, possibly because those cues do not exist as separate entities in the child’s memory. It is also difficult for these children to organize information on the basis of relationships between stimuli. In addition, children with ASD have difficulty transferring or generalizing learned information from one context to another. This difficulty reflects the inability of these children to identify the relevant contextual information. Conclusion As with other disorders that have been discussed, PDD demonstrates heterogeneity. Great differences are found in severity, especially in communication abilities. In general, these differences affect the pragmatic and semantic aspects of language and may reflect processing difficulties such as stimulus overselectivity and storage of unanalyzed wholes. Early intervention (EI) is critical to maximizing outcomes for children with ASD, but early identification is often difficult. Although SLPs alone do not make evaluations of children for ASD, they are a vital part of the evaluative team (Prelock, Beatson, Bitner, Broder, & Ducker, 2003). The American Academy of Neurology and Child Neurology Society (Filipek, Accordo, Baranek, Cook, Dawson, et al., 1999) has suggested that failure to meet the following milestones indicated need for further evaluation: babbling by 12 months • No No gesturing by 12 months • No single words by 16 months • No two-word spontaneous speech by 24 months • Loss of language or social skills at any age • These signs were specific to ASD. In addition, children with ASD also demonstrate deficits in joint attention and symbolic communication (Wetherby, Prizant, & Schuler, 2000). Given the limitations of current research, it may not be possible at this time to make a definitive diagnosis prior to 24 months of age (Woods & Wetherby, 2003).

Chapter 2

Language Impairments


B RAI N I NJ U RY Children with brain injury are often confused with other children who have impairments, such as children with LLD, ID, or emotional disorders. Children with brain injury differ greatly as a result of the site and extent of lesion, the age at onset, and the age of the injury. In general, the smaller the damaged area, the better the prognosis, or chance of recovery. Brain injury in children may result from trauma, cerebrovascular accident (CVA) or stroke, congenital malformation of the neural blood vessels, convulsive disorders, or encephalopathy, such as infection or tumors. Each has different characteristics; however, some similarities in language occur. Only the most prevalent types of injury are discussed here. Traumatic Brain Injury (TBI) Approximately 1 million children and adolescents in the United States have traumatic brain injury, or TBI, diffuse brain damage as the result of external physical force, such as a blow to the head received in an auto accident. TBIs are not congenital or degenerative. Individuals may range from nearly full recovery to a vegetative state in some very severe cases. Although the chances of survival have improved greatly in recent years, long-term disability is a continuing public health problem (Zitnay, 1995). Deficits may be cognitive, physical, behavioral, academic, and linguistic (Ewing-Cobbs, Fletcher, & Levin, 1985; Rosen & Gerring, 1986; Savage, 1991; Savage & Wolcott, 1988; Ylvisaker, 1986). Cognitive deficits include perception, memory, reasoning, and problem-solving difficulties. Such deficits may be permanent or temporary and may partially or totally affect functioning ability. Psychological maladjustment or acting-out behaviors, called social disinhibition, may also occur. For example, I once evaluated a young man with TBI who kept insisting on kissing my hand. Other characteristics include lack of initiative, distractibility, inability to adapt quickly, perseveration, low frustration levels, passiveaggressiveness, anxiety, depression, fear of failure, and misperception. Severity may range from a mild concussion, defined as a loss of consciousness for less than 30 seconds, through moderate TBI, a loss of consciousness or posttraumatic amnesia for 30 minutes to 24 hours, with or without skull fracture, to severe TBI, consisting of a coma for 6 hours or longer. Severity is not directly related to the deficits mentioned above (Russell, 1993). Variables that affect recovery are extremely independent and are complicated by some of the characteristics of the population at risk for TBI (Lehr, 1989; Middleton, 1989; Savage, 1991). In general, this population has a lower IQ, higher social disadvantage, poorer schooling, and more behavioral and physical difficulties prior to injury than the general population (N. Nelson & Schwentor, 1990). Other variables include degree and length of unconsciousness, duration of posttraumatic amnesia, age at injury, age of injury, and posttraumatic ability (Dennis, 1992; Russell, 1993). In general, shorter, less severe unconsciousness, shorter amnesia, and better posttraumatic abilities indicate better recovery. Age at the time of injury is a less definitive factor because the child is developing when the injury occurs. Younger children may exhibit more severe and more long-lasting problems. Although younger children have less to recover, they also do not have the benefit of as much past learning as older children. Age of the injury also can be an inaccurate predictor. In general, the older the injury, the less chance of change, but this aspect is complicated by the delayed onset of some deficits (Russell, 1993). Neural recovery over time is often unpredictable and irregular. Language Characteristics Language problems are usually evident even after mild injuries. Pragmatics seem to be the most disturbed aspect of the language of children with TBI. This fact can be noted


Part 1 Introduction

in the narratives and in conversation of these children (Chapman, 1997; Liles, Coelho, Duffy, & Zalagens, 1989; Mentis & Prutting, 1987). Utterances are often lengthy, inappropriate, and off-topic, and fluency is disturbed (Ylvisaker, 1986). Language comprehension and higher functions such as figurative language and dual meanings also may be affected. A child may lose his or her train of thought in conversations, while in narratives the same child may not retain the central focus of the story, thus deleting important information (Chapman, Watkins, Gustafson, Moore, Levin, et al., 1997). By comparison, language form is relatively unaffected. The majority of children with TBI regain the ability to manipulate language form and content (Chapman, Levin, Matejka, Harwood, & Kufera, 1995). Surface structure may seem relatively unimpaired. A child’s language may be effective in school until the third or fourth grade, when students are required to use higher language abilities to analyze and synthesize (Russell, 1993). Semantics, especially concrete vocabulary, is also relatively undisturbed, although word retrieval, naming, and object description difficulties may be present (Ewing-Cobbs, Levin, Eisenberg, & Fletcher, 1987). Other characteristics are listed in Table 2.11. Some deficits will remain long after the injury even when overall improvement is good (T. Campbell & Dollaghan, 1990; Ewing-Cobbs et al., 1987; Jordan, Ozanne, & Murdoch, 1988). Although there is considerable variability among children with TBI, many subtle deficits remain, especially in pragmatics (Dennis & Barnes, 1990). Possible Causal Factors Obvious biological and physical factors are involved in TBI. More important is the manner in which informational processing is affected. As mentioned, children with TBI are often inattentive and easily distractible. Attention fluctuates, and they have difficulty focusing on a task. TABLE 2.11

Language Characteristics of Children with Traumatic Brain Injury (TBI)


Difficulty with organization and expression of complex ideas. Off-topic comments. Ineffectual, inappropriate comments. Frequency of eye gaze is appropriate during conversation. Less complex narratives, containing fewer words and shorter, less sentences complexity, and fewer episodic elements. Short narratives include story grammar and cohesion, as do those of typically developing peers.


Word retrieval, naming, and object description difficulties, although vocabulary relatively intact. Automatized, overlearned language relatively unaffected.


Sentences may be lengthy and fragmented.


Few phonological difficulties, but there may be some dysarthria or apraxia due to injury.


Some problems due to inattention and speed of processing. Poor auditory and reading comprehension. Difficulty with sentence comprehension due to difficulty assigning meaning to syntactic structure. Most routinized, everyday comprehension unaffected. Vocabulary comprehension usually unaffected, except for abstract terms.

Source: Based on Butler-Hinz, Caplan, & Waters (1990); Ewing-Cobbs, Levin, Eisenberg, & Fletcher (1987); Hay & Moran (2005); Jordan, Murdock, & Buttsworth (1991); Mentis & Prutting (1987); Sarno, Buonaguro, & Levita (1986); Savage & Wolcott (1988); Turkstra (2005); Ylvisaker (1986).

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All aspects of organization—categorizing, sequencing, abstracting, and generalization—are affected. Children with TBI seem stimulus-bound—unable to see relationships, make inferences, and solve problems (Cohen, 1991; Ylvisaker, 1986). They evidence difficulty formulating goals, planning, and achieving (Ylvisaker & Szekeres, 1989). This deficiency often is masked by intact vocabulary and general knowledge. Finally, children with TBI exhibit memory deficits in both storage and retrieval. Long-term memory prior to the trauma is usually intact. Techniques presented in Table 2.6 might be helpful with these children. Cerebrovascular Accident (CVA) Cerebrovascular accidents occur when a portion of the brain is denied oxygen, usually because of a rupture in a blood vessel serving the brain. Most frequently, damage is specific and localized. Patterns of recovery suggest that adjoining portions of the cortex, the surface of the cerebrum, or upper brain, augment the functioning of the damaged portion (Papanicolaon, DiScenna, Gillespie, & Aram, 1990). CVAs usually are found in children with congenital heart problems or arteriovenous (blood vessel) malformations in the brain. Prognosis is generally good (Aram & Ekelman, 1987; Aram, Ekelman, & Whitaker, 1986, 1987). Naturally, the variability will be great, depending on the site and extent of the lesion. Language problems often accompany left hemisphere damage, although any brain damage has the potential to disturb language functioning. Language Characteristics Long-term subtle pragmatic difficulties are common. Language form usually returns quickly, although performance may deteriorate when demands increase. Word retrieval may be extremely difficult at first, with deficits in both speed and accuracy (Aram, 1988). Language comprehension also is affected initially. Children usually recover, although higher level academic and reading difficulties may persist (Aram & Ekelman, 1988). Conclusion The underlying relationship between cognition and language varies with age and with the aspect of language studied. At many points in development, we are not able to describe the exact relationship. It is not surprising that we cannot fully explain the mechanisms at work when the brain is injured. Still, we can predict that vocabulary and structural rules will return more easily than higher order functions, such as conversational skills that require complex synthesis of language form, content, and use. Even those children who seem to recover may continue to exhibit long-term subtle pragmatic difficulties. MALTR EATM E NT: N EG LECT AN D AB USE Each year in the United States, approximately 1.2 percent of children, or 900,000 children, are maltreated sufficiently for this information to be reported to the authorities (U.S. Department of Health and Human Services [DHHS], 2005). A study of over 50,000 typically developing children found that 9 percent had been maltreated (Sullivan & Knutson, 2000). The percentage is higher for young children and for those with disabilities. In the same study, 31 percent of children with disabilities and 35 percent of children with speech/language impairment had been maltreated. Although maltreatment occurs across the income spectrum, children from families earning less than $15,000 per year are over twenty times more likely to be abused than those from families earning at least twice that amount (Kapp, McDonald, & Diamond, 2001). It is believed that the increased eco-


Part 1 Introduction

nomic, social, and health problems and lower levels of education and employment of the poor increase the risk of maltreatment. Table 2.12 presents the types of neglect and abuse that have been identified (Sparks, 1989). Of the 900,000 maltreated annually, approximately 63 percent are neglected, 17 percent physically abused, 9 percent sexually abused, and 7 percent psychologically abused (U.S. DHHS, 2005). Until recently, these children were not identified as having distinct language problems. The effect of each type of abuse varies with each child. Neglect and abuse are extreme examples of a dysfunctional family and are a sign of the type of social environment in which the child learned language (Cicchetti, 1987; Cicchetti & Lynch, 1993; Salzinger, Feldman, Hammer, & Rosario, 1991). Although neglect and abuse are rarely the direct cause of the communication problem, the context in which they occur directly influences a child’s development. Complex trauma, or exposure both to domestic violence or maltreatment and to physical, sexual, and psycho-emotional abuse, rarely occurs in isolation and is often associated with substance abuse, mostly alcohol abuse, by parents. Adults who abuse alcohol are prone to violence, and their children are at risk (Willis & Silovsky, 1998). Whether these causal factors occur alone or together, they can lead to developmental difficulties across the lifespan (Timler, Olswang, & Coggins, 2005). Children exposed to both prenatal alcohol and postnatal abuse and neglect have lower intelligence scores and more severe neurodevelopmental deficits than traumatized children who are not prenatally exposed to alcohol (Henry, Sloane, & Black-Pond, 2007). Developmental deficits occur in language, attention, memory, visual processing, and motor skills. Sensory modulation dysfunction (SMD), introduced in the ASD section of this chapter, is also exhibited by children exposed to prenatal alcohol and/or postnatal abuse and neglect. Simply put, children who have been traumatized experience biological brain changes as a result (Atchison, 2007). Characterized as hyperarousal, these changes are associated with acceleration in nervous system areas responsible for perception and processing of potentially threatening sensations. The accompanying physiological changes, including release of certain stress hormones, influence thoughts, feelings, and actions. In a state of fear-related activation, the child responds to perceived threats with primitive, TABLE 2.12

Types of Neglect and Abuse

Physical neglect

Abandonment with no arrangement for care, including inadequate supervision, nutrition, clothing, and/or personal hygiene, and/or failure to seek needed or recommended medical care.

Emotional neglect

Failure to provide a normal living experience, including attention and affection, and/or refusal of treatment or services recommended by professional personnel.

Physical abuse

Bodily injury, such as neurological damage, or death from shaking, beating, and/or burning.

Sexual abuse

Both nonphysical abuse, such as indecent exposure or verbal attack, and physical abuse, such as genital-oral stimulation, fondling, and/or sexual intercourse.

Emotional abuse

Excessive yelling, belittling, teasing/verbal attack, and/or overt rejection.

Source: Adapted from Sparks (1989).

Chapter 2

Language Impairments


reflexive, and aggressive reactions. Over time, the hypervigilant state of the child leads to apprehension, fear, attention difficulties, and restlessness (Lane, 2002). Persistent activation of this response can result in a maladaptive, persistent state of fear (Perry, 1997). Language Characteristics Maltreated children have less complex language than nonmaltreated children (Eigsti & Cicchetti, 2004). All aspects of language are affected; however, it is in language use that children who are neglected and abused exhibit the greatest difficulties (see Table 2.13). In general, children who are neglected and abused are less talkative and have fewer conversational skills than their peers. Utterances and conversations are shorter than those of their peers. They are less likely to volunteer information or to discuss emotions or feelings. In school, these children have depressed verbal language performance. A high correlation is found between deficient verbal and reading ability and neglect and abuse (Burke, Crenshaw, Green, Schlosser, & Strocchia-Rivera, 1989). Possible Causal Factors Certainly, negative social-environment factors are important in the development of language by children who are neglected and abused, but biological factors should not be overlooked. Medical and health problems among the poor also can contribute. Direct effect is difficult to determine because of the multiplicity of overlapping factors, especially among the poor (Fox, Long, & Langlois, 1988; McCauley & Swisher, 1987; Sparks, 1989). Biological Factors Neglect and abuse are not limited to poor families, but in these families or in cases of extreme neglect, biological factors also may contribute. Poor maternal health, substance abuse, poor or nonexistent pediatric services, and poor nutrition can all affect brain development and maturation. Physical abuse also may cause lasting physical or neurological damage. We do not know the long-term effects on the brain of lack of environmental stimulation. TABLE 2.13

Language Characteristics of Children Who Are Neglected and Abused


Poor conversational skills. Inability to discuss feelings. Shorter conversations. Fewer descriptive utterances. Language used to get things done with little social exchange or affect.


Limited expressive vocabulary. Fewer decontextualized utterances, more talk about the here and now.


Shorter, less complex utterances.


Similar to peers.


Receptive vocabulary similar to peers. Auditory and reading comprehension problems.

Source: Based on Coster & Cicchetti (1993); Coster, Gersten, Beeghly, & Cicchetti (1989); Culp, Watkins, Lawrence, Letts, Kelly, & Rice (1991); Fox, Long, & Langlois (1988).


Part 1 Introduction

Social-Environmental Factors As in all children, the early language experiences of a child with a history of maltreatment influence the underlying social cognitive behavior of the infant or toddler (Lohmann & Tomasello, 2003). When children are repeatedly exposed to violence and stress, they compensate through behaviors that ensure their survival. These strategies can interfere with critical brain development in areas of socioemotional learning. As a result, these children have limited ability to predict and interpret the beliefs and intentions of others and to self-regulate their own language use. Some maltreated children exhibit alexithymia, difficulty in the identification, regulation, and understanding of feelings in others and, in extreme cases, in themselves. It is hypothesized that traumatic experiences result in a disassociation between right-hemisphere emotions and left-hemisphere expression (Schore, 2001). As a result, children with alexithymia may have behavioral problems or outbursts of aggressive behavior. Either or both parents may be neglectful or abusing, but it is a mother’s or caregiver’s everyday responsiveness to a child that has the most effect on language development. The quality of the child– mother attachment is a more significant factor in language development than is maltreatment and can moderate or exacerbate the effects of neglect or abuse (Gersten, Coster, Schneider-Rosen, Carlson, & Cicchetti, 1986; Mosisset, Barnard, Greenberg, Booth, & Spicker, 1990). Several factors, including childhood loss of a parent, death of a previous child, pregnancy complications, birth complications, current marital or financial problems, substance abuse, maternal age, and/or illness, can disturb maternal attachment. In turn, mothers may adopt two general patterns of interaction (Crittenden, 1988). Most abusive mothers are controlling, imposing their will on the child. As controllers, they tend to ignore a child’s initiations, thus decreasing the amount of verbal stimulation received by that child. Neglecting mothers, however, are unresponsive to their infant’s behaviors because they have low expectations of deriving satisfaction from the infant. Either situation includes a lack of support for the development of meaningful communication skills and little active interaction, such as playing games, hugging, patting, or nuzzling, and little nurturing maternal speech toward a baby (Allen & Wasserman, 1985). The result is insecure attachment on the part of a child (Browne & Sagi, 1988; Carlson, Cicchetti, Barnett, & Braunwald, 1989; Crittenden, 1988). The child may be apprehensive in the presence of the parent and may avoid interaction to lessen the chance of hostile responses. Early stimulus–response bonds—an infant’s notion that her or his behavior results in an adult reinforcing response—may be nonexistent, further depressing the child’s behavior. Obviously, this is not an ideal language learning environment. Conclusion Only now are we beginning to understand the effect of caregiver behavior on an infant. Although it seems intuitive that neglect and abuse would cause language and communication problems, especially in language use, the data are only correlational, not cause and effect. Although no practice that harms children can be condoned, professionals must be either mindful of different cultural practices or risk offending or alienating parents (Westby, 2007). By focusing on the welfare of the child, however, it should be easy to recognize when a family has crossed into maltreatment. It may be helpful to think of cultural childrearing practices as falling on a continuum from beneficial to harmful (Koramoa, Lynch, & Kinnair, 2002). Responses by professionals can vary according to where a practice falls on the continuum. Less-than-harmful corporeal punishment, for example, might best be handled by education. Culturally sensitive ways of approaching a family about childrearing and punishment might include the following (Fontes, 2002):

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Language Impairments


the laws regarding such practices • Explaining Exploring the goals and suggesting alternative methods • Explaining thefamily’s effects of harsh or corporeal punishment • Gaining the aid of professionals from the same culture • OTH E R LANG UAG E I M PAI R M E NTS Although we’ve touched on some of the more prevalent language impairments, we have by no means exhausted the discussion. I’ve omitted several forms of LI or related conditions for the sake of brevity. Let me at least familiarize you with some category names and brief descriptions. In order, we’ll explore nonspecific language impairment (NLI), late talkers, childhood schizophrenia, selective mutism (SM), otitis media, and children who have received cochlear implants. Disorders specifically related to literacy have been left for discussion in the chapter on literacy impairments. No doubt, your professor will have others to add to the list. Nonspecific Language Impairment (NLI) Children with nonspecific language impairment (NLI) have a general delay in language development, a nonverbal IQ of 86 or lower, and, as in SLI, no obvious sensory or perceptual deficits. Beyond this characterization, the population is poorly described in the disorder literature. Compared to children with SLI, these children perform more poorly on some language tasks and take longer to generalize rule learning (Rice, Tomblin, Hoffman, Richman, & Marquis, 2004). Late Talkers Although a significant number of late-talking children, possibly 40 to 50 percent, have persistent language problems throughout the preschool years, it is difficult to predict the effect of early delay on later development (Dale, Price, Bishop, & Plomin, 2003). Nor is the severity of early delay a good prognostic indicator. By age 4, late talkers without persistent LI do not differ from TD children in morphological development (Rescorla & Roberts, 2002); however, more subtle deficits may be present. Although child health is an important factor in early delay, most early language delay is environmental in origin. Environmental factors persist for children whose parents do not seek professional help such as SLP services (Bishop, Price, Dale, & Plomin, 2003). One environmental factor can be poverty and/or homelessness. Many children in homeless shelters exhibit language delays, but there is no common pattern. In fact, although the majority of both mothers and children in homeless shelters have some type of LI, the lack of a pattern of LI means that they do not form a distinct diagnostic category (O’Neil-Pizozzi, 2003). Childhood Schizophrenia Childhood schizophrenia, a serious psychiatric illness that causes strange thinking, odd feelings, and unusual behavior, is uncommon, occurring in approximately 1 of every 14,000 children below age 13 (APA, 2000). The disorder is difficult to recognize in its early phases, and the cause is unknown; it may result from a combination of brain changes and biochemical, genetic, and environmental factors. Although schizophrenia can be controlled by medical treatment, it is a lifelong disease that cannot be cured at the present time. Symptoms may include seeing and hearing things that are not real, called hallucinating; confusing reality and fantasy; exhibiting odd and eccentric behavior; confused


Part 1 Introduction

thinking and extreme moodiness; and severe anxiety and fearfulness. Behaviors may change slowly over time. Although there are slightly more males than females with the disorder, it is observed only rarely in children below age 5. In general, the earlier the symptoms appear, the poorer the prognosis. Among preschool children, approximately 30 percent who will develop schizophrenia have behaviors similar to those associated with pervasive developmental disorder (PDD) discussed earlier, such as rocking and arm flapping. It is not until early school age or later that children begin to display symptoms of hallucinations, delusions, and disordered thinking. Approximately 55 percent of children and adolescents with schizophrenia have language abnormalities, including language delay (Mental Health Research Association, 2007; Nicolson & Rapoport, 1999). Although there are few studies of the language of children with schizophrenia, data from adults suggest difficulty with pragmatics, especially in content relevancy (Griffin, Crowe, Byrne, & Penzien, 1994; Nicolson, Lenane, Singaracharlu, Malaspina, Giedd, et al., 2000). More specifically, adults have problems with appropriateness of topics and intentions, turn-taking, vocabulary, and nonverbal behaviors (Meilijson, Kasher, & Elizur, 2004). Selective Mutism Selective mutism (SM) is a relatively rare disorder in which a child does not speak in some situations, such as in school, although she or he may speak normally in others. From 0.2 to 0.7 percent of all children may have SM at some time, with girls nearly twice as likely as boys to be affected (Bergman, Piacentini, & McCracken, 2002; Kopp & Gillberg, 1997; Kristensen, 2000; Kumpulainen, Rasanen, Raaska, & Somppi, 1998). Related factors include social anxiety, extreme shyness, and LI or second language learning. Although 30 to 50 percent of children with SM are reported to have LI, the nature and extent of this impairment remains undetermined. Otitis Media Many young children suffer from chronic otitis media. In general, the cumulative effect of recurrent otitis media can be a significant factor in delayed language development (Feldman, Dollaghan, Campbell, Colborn, Janosky, et al., 2003). While otitis media is a factor in LI, children with otitis media do not constitute a separate category. Otitis media may co-occur with categories discussed previously, such as SLI or NLI. Deafness Although limited space precludes discussion of the language of children with deafness, it is important to note the effect of two things, early intervention and cochlear implants. Children born with deafness who receive both speech and sign training in infancy can often become proficient, if not perfect, speakers or develop language through sign, or both. Interestingly, children exposed to sign will express their first word in sign at about 8 months, while hearing children often don’t speak their first word until four months later. Those who receive cochlear implants develop language in a manner similar to that of typically developing children. In general, those implanted as infants show more rapid growth in language than those implanted later; however, the relationship is not simple (Tomblin, Barker, Spencer, Zhang, & Gantz 2005). Although those implanted later have an initial advantage of maturity that enhances lan-

Chapter 2


Language Impairments

guage growth, this advantage seems to disappear later as children who received implants at an earlier age begin to develop spoken language at an ever-increasing rate (Ertmer, Strong, & Sadagopan, 2003; Nicholas & Geers, 2007).

Conclusion At this point, most likely, you are in need of a one-sentence summary that once and for all distinguishes each language impairment from the others. Unfortunately, I do not have one forthcoming. Still, one needs to make some sense from the wealth of information presented. At the risk of generalizing too much, let’s try. At the beginning of the chapter, I cited six abilities needed for typical language development. It might be helpful to consider these in conceptualizing the language impairments discussed (see Table 2.14). Perceptual difficulties are reported for some of the disorders mentioned, but not all. Nor are they similar in type and severity. For children with SLI, perceptual difficulties seem to be limited to rapid, sequenced auditory stimuli, but perceptual difficulties are the essence of LLD and ASD. Even here the difference seems to be one of perception and sensory integration in LLD and threshold levels in ASD. Attentional difficulties also accompany several of the language impairments discussed. Again the variability is great. Children with ASD are either seemingly inattentive or fixated on one, often irrelevant, aspect of a stimulus. In contrast, children with TBI experience attentional fluctuations and seem to attend for only brief periods. Although all children with language impairment have difficulty using symbols, this difficulty varies. Children with ID and ASD have great difficulty with symbol referent relationships, while those who are neglected and abused have little difficulty with language form and content.

TABLE 2.14 Language Learning Requirements and the Difficulties of Children with Language Impairment* Language Impairment



Ability to perceive sequenced acoustic events of short duration Ability to attend actively, to be responsive, and to anticipate stimuli











Ability to use symbols






Ability to invent syntax from the language in the environment





Enough mental energy to do all the above simultaneously


Ability to interact and communicate with others *Xs represent problem areas in language learning and use.




Neglect/ Abuse




Part 1 Introduction

Language is rarely taught formally. Instead, children acquire language by hypothesizing the rules from the give-and-take of conversational speech. This can be a difficult task if the child is inattentive or has difficulty perceiving language, as are children with LLD, ASD, and TBI. The requirement of having enough mental energy is a tricky one. We shall broaden the concept somewhat. Children with ID may lack the mental abilities for some tasks, while those with SLI and TBI may use vital mental energy on lower level tasks, leaving little for language analysis and synthesis. The frequently reported depression of children with TBI and children who are neglected and abused also limits the cognitive energy available for language learning. Finally, the ability to interact and communicate with others probably is affected in each of the disorders discussed. The difficulty is in determining whether an inability to interact and communicate reflects a cause of the impairment, a result, both, or just an accompanying feature. Among at least two groups of children—those with ASD and those who are neglected and abused—inability to interact seems directly related to the language impairment exhibited. Each impairment presents a somewhat different image. In a clinical sense, however, the important features to which a SLP attends are the individual characteristics of each child, not the diagnostic category. Naming and describing a language impairment does not necessarily explain it nor determine clinical intervention. I M PLICATIONS Language impairments are not outgrown. Even with intervention, they are rarely “cured.” Typically, language impairments change and become more subtle (Wallach & Liebergott, 1984). Children with preschool LI may continue to have trouble with linguistic and academic tasks. Language impairments in kindergarten are likely to persist well into elementary school (Tomblin, Zhang, Buckwalter, & O’Brien, 2003). Reading performance may be affected (Hill & Haynes, 1992). As adults, children with LI may continue to do poorly in speech and language although nonlinguistic skills seem unaffected (Felsenfeld, Broen, & McCue, 1992). With or without intervention, certain ramifications of having an LI affect academic performance and social acceptance. Poor oral language usually results in poor reading and writing ability. It has been hypothesized that poor reading reflects the child’s lack of language awareness skills, called metalinguistic abilities (Menyuk, Chesnick, Liebergott, Korngold, D’Agostino, et al., 1991). For example, a child may be unaware of syllable or phonetic segmentation of words. This awareness is crucial for reading. Lack of these higher level language skills may explain the poor reading performance of children with SLI. Within the classroom, children with LI form a separate subgroup that interacts increasingly less with their peers developing typically (Guralnick, 1990; Hadley & Rice, 1991). One’s relative communication skills influence participation. Because children with LI are poor communicators overall (Fey, 1986), they are increasingly ignored. As a result, children with LI are more likely to be overidentified as having a socioemotional disorder (Redmond, 2002). In general, children with LI exhibit more behavior problems and poorer social skills than do their TD peers (Qi & Kaiser, 2004). The poor ability of these children to infer emotional reactions in social situation may contribute to the social difficulties they encounter (Ford & Milosky, 2003). Teachers rate children with LI significantly below their peers in impulse control, likability, and social behaviors such as helping others, offering comfort, and sharing (Fujiki, Brinton, Morgan, & Hart, 1999). Increasing reticence to talk leads to withdrawal, especially among prepubescent and adolescent boys (Fujiki, Brinton, Isaacson, & Summers, 2001).

Chapter 2

Language Impairments


In general, a child’s popularity is associated with her or his conversational skills (Hazen & Black, 1989). Children with LI initiate little verbal interaction, are less responsive, use more short and nonverbal responses, and are less able to maintain a conversation (Rice, Snell, & Hadley, 1991). The result is fewer interactions with others (Hadley & Rice, 1991). Children with LI often continue to have poor vocabularies and poor higher level semantic skills. These include difficulties with abstract meanings, figurative language, dual meanings, ambiguity, and humor (Donahue & Bryan, 1984; Kamhi, 1987; Nippold, 1985; Spector, 1990; Wiig & Semel, 1984). Syntax and morphology are usually characterized by the continued use of less mature forms (Curtiss, Kutz, & Tallal, 1992; Leonard, 1987, 1988). Word formation processes, consisting of a free morpheme plus one or more bound morphemes, are less mature (Clahsen, 1989; Leonard, Sabbadini, Leonard, & Volterra, 1987; Leonard, Sabbadini, Volterra, & Leonard, 1988; Rom & Leonard, 1990). Similarly, phonological patterns usually reflect those of younger children (Ingram, 1991; Shriberg, Kwiatkowski, Best, Hengst, & Terselic-Weber, 1986). Finally, language comprehension difficulties, especially at higher levels such as detection of ambiguity, may persist. These difficulties reflect the underlying language difficulties evidenced in expressive language (Skarakis-Doyle & Mullin, 1990). SLPs are responsible for intervening to correct some language difficulties, to modify others, and to teach compensation skills for still others. In the chapters that follow, we explore a model that proposes to do this in the most natural way possible.

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2 part

Communication Assessment C H A PTE R 3

Assessment of Preschool and School-Age Children with Language Impairment C H A PTE R 4

Assessment of Preschool and School-Age Children with Language Difference C H A PTE R 5

Language Sampling C H A PTE R 6

Analysis Across Utterances and Partners and by Communication Event C H A PTE R 7

Analyzing a Language Sample at the Utterance Level C H A PTE R 8

Narrative Analysis

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Assessment of Preschool and School-Age Children with Language Impairment


Part 2


Communication Assessment

till feeling overwhelmed by the list of possible disorders associated with LI? Here’s some comfort. First, as an SLP, you won’t be solely responsible for designating a child as one thing or another. You’ll be on a team with other knowledgeable professionals, although you’ll bring your own respected expertise. Ideally, your team will conduct a thorough assessment, weigh all the information, and make thoughtful and appropriate recommendations for intervention. Second, as you acquire more experience and become more skilled, you’ll learn to recognize patterns of behavior and signs that indicate the presence or certain underlying disorders. These patterns may not seem so obvious now. In the last analysis, however, nothing is a substitute for the data you systematically gather through an individualized, well-designed, thorough assessment of a child’s communication skills and deficits. No clear line exists between assessment and intervention. Both are part of the intervention process, and portions of each are found in the other. Ideally, assessment and measurement are ongoing throughout intervention. No clinical goal should be determined or modified without first obtaining data on the communication performance of a child. Adequate evaluation is one of the most difficult and demanding tasks faced by an SLP. The goal— much more complex than providing a score or a diagnostic label—is to describe the very complex language system of each child. Each has a unique pattern of language rules and behaviors to be revealed and described. As an SLP, keep in mind the why, what, and how of assessment. Considering why a child is being assessed helps you clarify the purpose of the assessment. This clarity, in turn, enables you to decide what specific behaviors to assess and the best evaluative methods to use. The reasons for assessment can be grouped as (a) identification of children with potential problems, (b) establishment of baseline functioning, and (c) measurement of change. Baseline functioning enables an SLP to determine the present level of performance, the extent of the language impairment, and the nature of the problem. The data-gathering process is scientific in nature in that it must be unbiased and objective. This collection process should be precise and measurable, with very little intrusion by an SLP’s premature conclusions. It is important, however, not to lose the child in the mass of data you’ll collect, and clinical intuition is an important factor when summarizing data and determining which aspects of language to evaluate. It may be helpful to consider assessment procedures as existing along a continuum from formal, structured protocols to informal, less structured approaches. In general, the more structured the elicitation session, the less variety of structures and meanings expressed. Language elicited in more structured tasks is usually shorter and less complex, especially with younger children, than language sampled in less controlled situations (Fey, Leonard, & Wilcox, 1981). Generally, the more specific the information desired, the more structured the approach. In this way, assessment procedures can help an SLP sharpen and focus what observed. Even formal tests or portions of tests can be used in an informal way as a probe of specific behavior. More on this later. In this chapter, we explore the differences between psychometric and descriptive assessment paradigms and describe a combined, or integrative, approach that attempts systematically to address the shortcomings of both approaches while describing a child’s use of language in context. After discussing the integrated approach and applying it to more typical language impairment cases, we’ll discuss some of the special needs of children with LI.

Chapter 3

Assessment of Preschool and School-Age Children with Language Impairment


Psychometric Versus Descriptive Procedures The goals of communication assessment are to identify and describe each child’s unique pattern of communication behaviors and, if that pattern signifies a language impairment, to recommend treatment, follow-up, or referral. Through this process, an SLP determines a problem exists. • Whether The causal-related factors. • The overall intervention plan. • There are two major philosophical approaches to this task. The normalist philosophy is based on a norm, or average performance level—usually a score—that society considers typical of normal functioning. In contrast, the neutralist, or criterion-referenced, approach compares a child’s present performance to past performance and/or is descriptive in manner. The features of each approach are presented in Table 3.1. The two methods are really modes of interpreting measurable behavior and are not mutually exclusive (McCauley, 1996). For example, the results of testing can be reinterpreted to provide more descriptive information, including categories of behavior not included in the test and success with different formats (Olswang & Bain, 1996). Test items on which a child is unsuccessful can be probed to determine other methods that result in a correct response. Tests are usually standardized and normed. Standardized means that there is a consistent manner in which test items are to be presented and child responses consequated. For example, the test manual may direct an SLP to give the following instructions: I am going to read a sentence to you. When I’m finished, I want you to select the picture that best illustrates what I have said. Listen carefully, because I can only read each sentence once. The test is to be administed in this manner. Most standardized tests are also normed, which means that the test has been given to a group of children that supposedly represent all children for whom the test was designed and scores determined for typical functioning. Ideally, the norming group has the same characteristics as the children for whom it’s designed. In other words, gender, racial and ethnic, TABLE 3.1

Comparison of Norm Referencing and Criterion Referencing

Norm Referencing

Criterion Referencing

Fundamental purpose is to rank individuals.

Fundamental purpose is to distinguish specific levels of performance.

Test planning addresses a broad content.

Test planning addresses a clearly specified domain.

Items are chosen to distinguish among individuals.

Items are chosen to cover content domain.

Performance can be summarized meaningfully using percentile or standard scores.

Performance can be summarized meaningfully using raw scores.

Source: Reprinted with permission from Familiar strangers: Criterion-referenced measurements in communication disorders by R. J. McCauley. Language, Speech, and Hearing Services in Schools, 27, 122–131. Copyright © 1996 by American Speech-Language-Hearing Association. All rights reserved.


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Communication Assessment

geographic, and socioeconomic differences present in your children are also represented in the norming group in the same proportions. Even these constraints do not ensure that the test will be appropriate, especially with children from culturally and linguistically diverse backgrounds. Usually, children with LI are rarely included in the norming group. This may surprise you. Traditional language assessment procedures heavily emphasize the use of standardized psychometric or norm-referenced tests. This situation is reflected in the fact that more than 100 norm-referenced language assessment tools are commercially available. In general, there are very few standardized measures for toddlers and adolescents and an abundance of measures for preschoolers and early-schoolage children. Ideally, a standardized test has been given to a large number of children from various populations, has demonstrated reliability and validity, and has normative data that provide scale score, age equivalent, or numerical score comparisons. Reliability is the repeatability of measurement. More precisely, reliability is the accuracy or precision with which a sample of language taken at one time represents performance of either a different but similar sample or the same sample at a different time. Factors that may affect reliability include individual change over time, sample differences, and the nature of the language sample in size or inclusiveness. Very limited samples of language usually result in unstable or undependable scores. Thus, a test must include enough language to be reliable yet not unwieldy. Add to these concerns the great difficulty in obtaining consistent performance from children, and the chance of producing a reliable measure decreases. Test makers and users are concerned with both internal consistency and various measures of reliability. Internal consistency is the degree of relationship among items and the overall test. If a test has high internal consistency, children who score well overall should tend to get the same items correct, whereas those who score low should tend to perform similarly among themselves. Measures of reliability include test-retest reliability, alternate-form reliability, and split-half reliability. In test-retest reliability, a child is administered the same test with a time interval between each administration. With alternate forms, a child is administered equivalent or parallel forms of a measure. Finally, a test may be divided into equivalent halves. In each case, the two test scores are compared and the consistency of scores measured. This value is expressed as a reliability coefficient or as a standard error of measure (SEm). The closer the reliability coefficient to a value of 1 and the lower the standard error, the more reliable is the measure. In other words, a reliability coefficient of .84 indicates greater reliability than one of .62. SEm will be discussed in more detail later. In addition, an SLP is concerned with the probability of two judges scoring the same behavior in the same manner. This value is called interjudge reliability. As a group, scoring procedures that use a definite criterion, such as accepting only specific responses as correct, are more reliable than those that use scaled scoring, such as grading responses (1–5) by their degree of correctness. Graded scores can have increased reliability if each score has definite criteria or if the tester has received specific training. Validity is the effectiveness of a test in representing, describing, or predicting an attribute of interest to the tester. In short, it is a measure of the test’s ability to assess what it purports to assess. The tester is interested in measuring all of the attribute being tested but nothing other than that attribute. For example, if a test of receptive language abilities requires a child to respond verbally, it goes beyond the stated domain of the attribute being tested. Professionals should be cautious when choosing tests. Few language screening tests, for example, meet criteria for validity or provide information to enable SLPs to determine validity (Sturner, Layton, Evans, Heller, Funk, & Machon, 1994).

Chapter 3

Assessment of Preschool and School-Age Children with Language Impairment


To test an abstract concept such as intelligence, test designers must select concrete tasks (Kamhi, 1993). These tasks, in turn, often become the defining features of the abstract entity supposedly measured. For example, intelligence becomes the sum of the test tasks when it is clearly much more. Tests do not represent the overall attribute or behavior but are merely samples. From the samples, testers make inferences about the overall attribute or behavior. If the samples are not valid measures, the inferences will be incorrect. Validity is not self-evident and must be proven. Three types of evidence are criterion validity, content validity, and construct validity. Criterion validity is the effectiveness or accuracy with which a measure predicts success. This usually is calculated as the degree to which a measure correlates with some other suitable measures of success assumed to be valid. Content validity is the faithfulness with which the sample or measure represents some attribute or behavior. In other words, the sum of the tasks involved should define or constitute, at least in part, the attribute or behavior being measured. Measures should reflect the professional literature, research, and expert opinion on the constitution of the attribute or behavior tested. Finally, construct validity is the extent to which a measure describes or measures some trait or construct. Professionals are interested in the significance of results and in how precisely the measure notes individual or group differences. Construct validity usually is determined by comparing the measure with other acceptable measures assumed to be valid. One study found that one-third of the kindergartners who failed one of two language screening tests passed the other, possibly indicating that the tests assessed different aspects of language (Summers, Larson, Miguel, & Terrell, 1996). Tests, or measures, help the SLP determine how a child’s performance, in the form of a score, compares with that of children who supposedly possess the same characteristics (McCauley & Swisher, 1984a, 1984b). Most frequently, tests are used to determine average and less-than-average performance for decisions about the need for intervention services (Lund & Duchan, 1993). Unfortunately, many traditional assessment procedures do not reflect current definitions of the nature of language (Ray, 1989). Although normative tests may be good for measuring isolated skills, they provide very little information on overall language use. More descriptive approaches, such as language sampling, can highlight the individualistic nature of a child’s communicative functioning. In contrast, psychometric normative testing imposes group criteria on an individual, thereby obviating an assessment of the individual. Each method of assessment has its strengths and weaknesses, as well as possible applications within the clinical setting. These are described in the following sections.

Psychometric Assessment Protocols Ideally, a test elicits a standard and representative sample of a behavior. A test is normed by using specified explicit procedures and administering the test to a sample from a specific population, such as all English-speaking first graders in the United States. Normed tests enable an SLP to compare individual performance with that of a larger population. In general, norm-referenced assessment tools have the advantages of objectivity, replicability, and elimination of unwanted or uncontrolled variation. Tests are particularly helpful when deciding whether a problem exists. Although normed tests are potentially valid, reliable, and precise in measurement, it is difficult to find a language test that is acceptable in all three ways. In addition, normed tests do not easily accommodate cultural and individual variation, nor do they begin to provide a true picture of the richness


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Communication Assessment

and complexity of the child’s communication behavior. In other words, “at their best ... tests provide an unclear picture of communication performance” (L. Miller, 1993, p. 13). By their nature, tests are less complex than the language being assessed (Ray, 1989). Language is multidimensional and its use individualistic, making it difficult to measure (Damico, 1988). Most SLPs are either neutral or negative toward existing language tests. School-based SLPs are more negative. The main concerns seem to be the length of time needed for administration and interpretation and the inadequacy of most tests for use with multicultural populations (Huang, Hopkins, & Nippold, 1997). TEST DI FFE R E NCES Language assessment instruments differ widely even when purported to measure the same entity. Even tests that seem to be significantly correlated, suggesting an interrelationship, may seem less so when subtests or various portions of tests are compared. Nor does positive correlation mean that tests are acceptable substitutions for each other (Friend & Channell, 1987). In addition, tests can differ markedly in their levels of difficulty (Lieberman, Heffron, West, Hutchinson, & Swem, 1987). Task variability, or the way in which something is tested, is also a big factor and can affect test results, yielding different results for the same child for the same skill (Fagundes, Haynes, Haak, & Moran, 1998). All tests are not created equal and should be researched carefully by SLPs before being used. In the following section we explore some of these differences, specifically test content, and some of the common misuses of tests. Finally, the variables that should be considered in test selection are discussed. CONTE NT The major criticism of existing instruments is the inadequacy of the content covered in both breadth and depth. Two issues relative to content validity—relevance and coverage—must be addressed in test construction. Content relevance is the precision with which a certain aspect of language is delineated or defined. This is necessary to determine the dimensions of that aspect to test. The issue of content relevance is made more complicated by our lack of an agreed definition of language (Lahey, 1990). In addition, a child’s knowledge of language, called competence, is measurable only as behavior or performance, which is affected by contextual variables, such as speed and complexity. Thus, poor performance may indicate an underlying deficit or difficulty with the assessment procedure, or the test content. Content coverage is the representativeness with which an aspect of language is sampled. Theoretically, coverage of language features should reflect general use. Some features may be more significant than others; however, this fact can be verified only through statistical analysis. Otherwise, subtle language impairments may go undetected. A single test’s rather limited sample of a child’s skills is an inadequate base on which to build a sound remedial program (Lieberman & Michael, 1986). The psychometric testing model produces data on minimal portions of behavior, thus reducing language to simple, possibly irrelevant dimensions that may not reflect the qualities of that language overall (Kamhi, 1993). By fragmenting language into observable and measurable features, tests may highlight skills only tangentially related to language ability. Tests tend to emphasize structural components of language because they are easy to observe. Although structured testing may reveal the child’s ability to use language in one context, it reveals very little about the child’s language as it is needed and used in everyday communication.

Chapter 3

Assessment of Preschool and School-Age Children with Language Impairment


In addition, language use in an isolated test situation may bear little resemblance to language use in everyday contexts (Newman, Lovett, & Dennis, 1986). For example, a child may use interrogatives throughout the day to obtain information, desired objects, and needed assistance but may be unable to form interrogatives in isolation when given a group of words to include. In addition, the test situation may be so foreign to a child or that child’s everyday communication environment that it influences the language the child produces. Performance may be affected also by factors as diverse as a child’s state of health on the day the test is administered, attention level and comprehension of the instructions, and perception of the test administrator. In short, norm-referenced approaches offer “canned” assessment with little consideration for the individual needs of the child with whom they are used. The tendency is for assessment procedures to take priority over the child, especially when test selection is based on commercial availability or clinical popularity (Duchan, 1982a; Kamhi, 1984). Tests are a priori and product oriented, offering little information on the appropriateness of the features being tested. Test results, in turn, offer little assistance in identifying individual problems and in planning intervention. M ISUSE OF NOR MATIVE TESTI NG Norm-referenced tests should be used with caution. The best advice is to be an “informed clinician” and a wise consumer. SLPs should be mindful of the frequent misuse of these instruments (Lieberman & Michael, 1986; Stephens & Montgomery, 1985), among them (a) misuse of scores as a summary of a child’s performance, (b) use of inappropriate norms, (c) inappropriate assumptions based on test results, (d) use of specific test items to plan intervention goals, and (e) use of tests to assess therapy progress. Let’s discuss each briefly. Misuse of Scores When does difference become disorder? We should remind ourselves that the 1 percent of the population who are blood type B-negative is not considered deviant, just different (L. Miller, 1993). So how do we decide? The most frequently used score on standardized measures is the mean, or average, score. Test makers assume that the average score for a sample population is the “normal” score for the larger population. When plotted, the total number of individuals receiving each score will form the familiar bell-shaped curve, represented in Figure 3.1. It is important to recall that a wide scoring area about the mean, called one standard deviation, also is considered to fall within the normal range. Approximately two-thirds of the population will score within 1 standard deviation on either side of the mean score. An SLP must decide where “nonnormal” or disorder occurs. If she uses only 1 standard deviation for separating normal from nonnormal, she will find that nearly one-third of the population, approximately 16 percent above and 16 percent below, fails to fall within this range. Two standard deviations is a better index of deviancy, leaving approximately 3 percent of the population above and 3 percent below those within the normal range. A second index is the 10th percentile, the lowest 10 percent of the norming sample. Children who score at or below the 10th percentile are often considered to be other-than-normal. Scores at either end of the distribution represent a quantitative difference that can be called disordered, exceptional, or impaired. Obviously, our boundary of 2 standard deviations is relative. The SLP must decide when the difference is so great as to impair an individual.

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1 Standard Deviation


Scores X 2 Standard Deviations

FIGURE 3.1 Parameters of the normal distribution.

The use of scores imposes some constraints that many professionals overlook. First, numbers establish equalities and inequalities. For example, 2 is twice 1 and half of 4. It would seem, therefore, that a child with a score of 4 correct has twice the skill of one with a score of 2, but this is a measure of the number of responses, not their quality. Second, all test items are assumed to be equal because each has the same weight (L. Miller, 1993). If there is one item each for the verb to be and past-tense -ed, they each receive the same score even though they are not of equal importance developmentally. Beyond concerns about numerical equalities-inequalities, an SLP must consider the standards for comparison of children, such as chronological, mental, or language age. For example, it seems inappropriate in most cases to give a diagnostic test designed for 6-year-olds to a 6-year-old child with ID who is functioning at age 3 unless our goal is to confirm that the child is in fact retarded. Scores imply some standard of performance when in fact there may be none, except the numerical score. The use of age-equivalent scores—the average or projected age of children getting a certain number of items correct—for example, can lead to erroneous assumptions about children’s behavior. The equality of scores does not translate to an equality of behavior and offers an inadequate description of that individualistic behavior. A child who achieves the same score as a younger child may not make the same kinds of errors (Lawrence, 1992). Two children with the same scores could have answered very different items correctly. Speech-language pathologists habitually should check the standard error of measure (SEm) for information about the confidence of test scores (J. Brown, 1989). Because tests are less than perfectly reliable, a certain amount of error is reflected in each score. The larger the SEm, the less confidence one can have in the test’s results. The SEm can be added to and subtracted from a test score to establish a band of confidence. For example, assume that a child received a score of 75 on two different tests with confidence intervals of 2 and 6, respectively. On the first test, the child’s error-free, or true, score is most probably 73–77; on

Chapter 3

Assessment of Preschool and School-Age Children with Language Impairment


74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 A


SEm = ± 6 SEm = ± 6 Overlap FIGURE 3.2

A comparison of scores using standard error of measure.

the second, it is 69–81. The SLP can have more confidence that the score of 75 on the first test is closer to the child’s actual performance. Larger SEm values also may mean that scores that seem very different actually overlap, as shown in Figure 3.2. Child A received a score of 81, and Child B received a score of 90. An SEm of 6 applied to each score results in an overlap. Therefore, the children’s actual abilities may be much more similar than the test scores alone indicate. An SLP should check the test manual to obtain the SEm. Because this information is not always available, the SLP may wish to determine this value from Table 3.2 (J. Brown, 1989). The entering values of standard deviation and reliability coefficient usually are provided in the test manual. Quantification or scoring of behaviors is not inherently bad. Measurement should be meaningful and functional and should reflect accurately the entity being evaluated (Kamhi, 1993). It is important that test designers define the entities being tested and provide a rationale in the test manual for the tasks selected. SLPs should read, understand, and evaluate the manual accompanying the test and be knowledgeable about test construction and administration (Stephens & Montgomery, 1985). Evidence-based practice requires that the professional literature about a certain test be studied thoroughly before the test is used. Inappropriate Norms Often, the norming sample does not represent the population with which an SLP is using the test (Lahey, 1990). In this situation, the norms are inappropriate and should not be used. This situation occurs most frequently with minority or rural children or with children from lower socioeconomic groups. In these cases, local norms should be prepared by an SLP by following the norming procedure described in the test manual. Some test manuals, such as those for the Test of Language Development–Intermediate (TOLD-I) and the CELF, explain this process in detail. Finally, we cannot assume that norms are stable. They change over time. In addition, changes in the format of the test, such as offering it on computer, also change the norms. Separate norms are needed when a test is offered in a computerized format (Wiig, Jones, & Wiig, 1996). If a test is given in an other-than-standardized manner, resultant scores should not be compared to the test’s norms. There may be occasions when administration procedures need to be minimally modified, such as allowing a child with cerebral palsy to use a head pointer rather than pointing by hand, and it is your clinical judgment that the changes are nonsignificant. If you use the norms, however, you should state in your report that an alternative method was used.


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TABLE 3.2 Table of Standard Error of Measure Reliability and Standard Deviation Values to Estimate the Standard Error of Measure (SEm) Reliability Coefficient Standard Deviation

30 28 26 24 22 20 18 16 14 12 10 8 6 4 2











6.7 6.3 5.8 5.4 4.9 4.5 4.0 3.6 3.1 2.7 2.2 1.8 1.3 .9 .4

9.5 8.9 8.2 7.6 7.0 6.3 5.7 5.1 4.4 3.8 3.2 2.5 1.9 1.3 .6

11.6 10.8 10.1 9.3 8.5 7.7 7.0 6.2 5.4 4.6 3.9 3.1 2.3 1.5 .8

13.4 12.5 11.6 10.7 9.8 8.9 8.0 7.2 6.3 5.4 4.5 3.6 2.7 1.8 .9

15.0 14.0 13.0 12.0 11.0 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0

16.4 15.3 14.2 13.1 12.0 11.0 9.9 8.8 7.7 6.6 5.5 4.4 3.3 2.2 1.1

17.7 16.6 15.4 14.2 13.0 11.8 10.6 9.5 8.3 7.1 5.9 4.7 3.6 2.4 1.2

19.0 17.7 16.4 15.2 13.9 12.7 11.4 10.1 8.9 7.6 6.3 5.1 3.8 2.5 1.3

20.1 18.8 17.4 16.1 14.8 13.4 12.1 10.7 9.4 8.0 6.7 5.4 4.0 2.7 1.3

Note: This table of standard error of measurement is based on the formula SEm = SD 1 − r11 where SD is the standard deviation of the test scores and r11 is the reliability coefficient for internal consistency of the test scores. Source: Reprinted with permission from The truth about scores children achieve on tests by J. Brown. Language, Speech, and Hearing Services in Schools, 20, 366–371. Copyright © 1989 by American Speech-LanguageHearing Association. All rights reserved.

Incorrect Assumptions Test scores may represent only scores and not actual differences in linguistic ability. Therefore, an SLP must analyze each child’s performance in order to obtain descriptive information. For example, subtest scores can be interpreted independently from each other. An SLP also should be cautious in extrapolating global language development from scores on language tests, especially those that sample only one or two aspects of language. The Peabody Picture Vocabulary Test (PPVT) is an excellent receptive vocabulary test, but it does not address other aspects of language or indicate overall language use. Identifying Intervention Goals A thorough description of a child’s behavior is needed before an SLP can identify areas needing intervention. Individual test items or subtests do not provide an adequate sample of that behavior. Because test items represent only a small portion of language, they do not provide enough information on which to base therapy goals. At the very least, more than one psychometric assessment procedure

Chapter 3

Assessment of Preschool and School-Age Children with Language Impairment


should be used because of the variability of some children across tests (Stephens & Montgomery, 1985). The more test scores available, the more reliable the assessment. Only through the use of a number of assessment protocols can the SLP hope to determine intervention objectives (Lahey, 1990). Psychometric tests should be only a portion of the assessment process. Measuring Therapy Progress The continued use of a norm-referenced test to assess therapy progress may result in a child’s learning the test, thus producing artificially high results. However, widely spaced testing or the use of different forms of the same test or of different but highly correlated tests can demonstrate changes in behavior over time (McCauley & Swisher, 1984b). Just remember that all test items are not equal. A child whose score has changed little may have made more progress than another child whose score has changed more. Criterion-referenced tests, explained later in the chapter, are more appropriate for measuring individual progress. VAR IAB LES I N TEST SE LECTION An SLP should be a wise consumer of assessment materials and should base test selection on several factors. Of particular interest are test reliability and validity, discussed previously. Even language tests that meet very stringent psychometric or measurement criteria may not be very precise discriminators of impaired and nonimpaired language (Plante & Vance, 1994). Other considerations in test selection include appropriateness of the test for a particular child, the manner of presentation and comprehensiveness, and the type and sensitivity of the test results. A test should be appropriate to the child’s age or functioning level. In addition, the norming population should be sufficiently large and varied to include representatives of the child’s racioethnic and socioeconomic background. If the child is from an identifiable minority, the SLP should check to see whether the norming information gives data by such groups. Appropriateness may relate also to manner of presentation, which usually reflects the overall theoretical basis of the test. A sentence imitation test, for example, relies on auditory processing of verbal stimuli, rather than on picture cues. Other practical issues related to presentation include the number of items and the content coverage discussed previously. Some children perform better under certain conditions than under others. For example, children with LLD can perform better if visual input accompanies the verbal. Some tests offer a computerized version for children with motoric problems or those who may perform better on this format. Results of computerized test formats seem to be equivalent to those from the standard form of administration, but this will vary across children (Haaf, Duncan, Skarakis-Doyle, Carew, & Kapitan, 1999). The type of result, whether percentage, percentile, or age equivalent, is also a practical consideration in test selection. Depending on the test, the interpretive value of such scores may be very limited. When given a choice of different tests, SLPs display a remarkable similarity in the relative importance they attach to different measures (Records & Tomblin, 1994). Receptive measures, such as the Test of Auditory Comprehension of Language (TACL) and the PPVT are relied on heavily. Sentence imitation and grammatical closure tasks in which a child fills in a blank also are preferred. Familiarity with the test procedure, overall opinion of the measure, and clinical experience are all factors in test or task selection and in the relative importance attached to data obtained from different measures.


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SU M MARY Perceptive professionals decry overdependence on and poor interpretation of the results of testing. Although standardized tests, especially those in language, frequently have been maligned, SLPs often are required to incorporate the results of these procedures into their overall assessments. It is important for SLPs to recognize that tests are informative, but not the be-all and end-all of evaluation. Awareness of a test’s shortcomings can greatly aid the interpretation of a child’s performance (Stephens & Montgomery, 1985). The issue of testing is central to the purpose of assessment. Data gathered in an assessment should be relevant to the initial clinical complaint, to the determination that a problem exists, to individual differences and individual processing, to the nature of the problem, to prognosis, to intervention implications, and to accountability (Muma, 1986). Otherwise, it is just a numbers game. Although normreferenced tests seem appropriate for determining if a language impairment exists, they are inconsistent in determining the specific area(s) of deficit (Merrell & Plante, 1997).

Descriptive Approaches The descriptive approach, usually based on observation and a conversational sample of a child’s language, is a widely taught method of defining children’s communicative abilities. Unfortunately, because of time constraints the method is not widely used, but it continues to gain favor. Descriptive approaches have the potential of allowing SLPs to regard the language process while maintaining contextual integrity and individual differences (Muma, 1986). Spontaneous sampling alone is best used as an indicator of a child’s overall language functioning rather than as a device for noting specific language problems. More specific data can be obtained by probing the child’s conversational behavior. In general, data from a language sample correlate significantly with results from elicited imitation and sentence completion tasks; however, the syntactic structural patterns vary widely (Fujiki & Willbrand, 1982). The advantages of the descriptive approach are that an SLP can apply his or her own theoretical model to the assessment process and can probe and assess areas that seem most handicapping to a child. For example, an SLP who follows a sociolinguistic model of language is free to explore the pragmatic and conversational aspects of a child’s language. Thus, the clinical process can remain flexible and attuned to the client’s needs (Kamhi, 1984). To do this, an SLP must understand the complex interaction of constitutional—biological, cognitive, psychological, and social—and environmental forces. A speech sample has several advantages over more formal structured-response testing, which reveals little about the use, content, and form of a child’s language as needed and used in daily living. For example, single-word responses on a test may not be as adequate a database for analysis as a longer conversational response might be. Some language features are more sensitive to the linguistic and extralinguistic factors of conversational give-and-take (McLeod, Hand, Rosenthal, & Hayes, 1994). The disadvantages of the descriptive approach are (a) the level of language expertise needed by an SLP in order to elicit and analyze a child’s language, (b) the length of time needed to collect and analyze the child’s language, and (c) the reliability and validity of the sample (Kelly & Rice, 1986). Although a number of descriptive protocols exist, an SLP may not feel sufficiently well versed in all aspects of language to choose those appropriate for each child. For example, many theoreticians place great value in the pragmatic functions of each utterance. Yet, an SLP may not be comfortable with the pragmatic

Chapter 3

Assessment of Preschool and School-Age Children with Language Impairment


aspects of language. In addition, a large caseload may preclude the use of lengthy descriptive procedures. Finally, as in psychometric testing, the SLP may not elicit a reliable or valid sample of a child’s usual language usage. R E LIAB I LITY AN D VALI DITY Language samples are more susceptible than standardized measures to SLP bias, especially when used to assess intervention effectiveness (Nye et al., 1987). An SLP must attempt to analyze the language sample in the most objective manner possible. Objective descriptions of the actual behaviors observed are generally more reliable than subjective judgments of the causes or reasons for these behaviors. One way to increase reliability is to separate the actual events from inferences based on these events and to base decisions on the data from these events. Reliability across observations can be increased by taking the following three precautions: 1. Define the behaviors to be observed as explicitly as possible, and train observers to ensure good inter- and intraobserver reliability. The selection of behavior categories to be observed will affect the validity of the observation. For example, it may be easier and more accurate to identify certain gestures than to record verbal intentions. Accuracy can be controlled by making comparisons between the ratings of two observers. This type of analysis helps sharpen definitions and to highlight possible areas of confusion. 2. Make judgments on only one type of behavior at a time. This procedure may require the use of videotaping or digital recording so that a language sample can be replayed often for additional judgments on other behaviors. 3. Do not make summation judgments while observing “on-line.” It is too easy for preconceived notions of the child to influence our interpretation. Judgments about overall behavior are best made after assessing the accumulated data. There is danger in attempting to fit the child into one of the language impairment categories mentioned in Chapter 2. Some threats to validity are found within the sample itself. For example, preschool children vary in their attentiveness and disposition to talk moment by moment. Given this condition, the possible threats to validity in a speech sample, even with older children, are productivity, or the amount produced; intelligibility, or the amount understood by the listener; representativeness, or the typicality of the sample; and reactivity, or the response of the child to differing stimuli (Shriberg & Kwiatkowski, 1985). Productivity The uncommunicative child or the child who says very little will not give an SLP a productive sample from which to work even though such a sample may reflect accurately the child’s typical output. The child may have little language with which to talk. The key to greater production is for the SLP to plan a variety of elicitation tasks that serve the purpose of gathering the sample (Wren, 1985). Intelligibility Intelligibility is the amount of agreement between what a child intended to say and what the SLP interpreted from the sample. If much of the sample is unintelligible, few utterances will be suitable for


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analysis. In general, intelligibility can be increased with increased SLP control over the content of the child’s utterances. In short, the SLP who knows the topic can determine more easily what the child said. Representativeness A sample may not represent a child’s typical behavior. Language samples often are collected in an atypical context, for example, a clinical room with an unfamiliar SLP as the conversational partner. Much of the sample may be atypical when removed from a child’s typical conversational context (Roth & Spekman, 1984b). Three issues are relative to the representativeness of the conversational sample: spontaneity, variability of context, and stability of the structure/function sampled (Muma, 1983). Spontaneity is increased if the child is allowed to establish the topic and/or the activity. Interesting and varied stimulus materials can provide an excellent basis for spontaneous conversation and can elicit a variety of forms and functions. Variability of the context and stimulus items will elicit a greater variety of child behaviors theoretically more representative of the child’s everyday behavior. Data should be collected in a variety of settings, with a variety of partners, and on a variety of child-based conversational topics to ensure versatility. Because quantity and complexity vary with the task, no individual task is likely to yield a representative sample of a child’s language (Wren, 1985). Unrepresentative samples may reflect other-than-normal usage by a child. In this situation, the structures or functions sampled may vary widely from one situation to another. Everyday situations are most likely to elicit typical use and thus provide some stability across situations. Some discussion has concerned whether SLPs should try to elicit typical or maximum production from a child. This debate is fueled by the often-reported gaps between what children with LI are capable of doing with their language and what they typically do. An SLP must decide on the appropriate task to use. For example, storytelling tasks yield longer utterances, while picture interpretation tasks elicit greater language quantity. Various elicitation tasks will be discussed in detail later. Reactivity A child’s reaction to the techniques and the materials also will affect the overall validity of the sample produced. Sampling conditions and the nature of the content or stimuli available can greatly affect the sample. A directed condition, such as one in which an SLP uses a questioning technique, allows the examiner more control over the content being discussed and may, in turn, increase intelligibility. Unfortunately, this improved intelligibility may sacrifice productivity and representativeness. In general, too much control restricts a child’s output. For example, sentence-building tasks in which a child is asked to “Make a sentence with the word X” elicit the least typical language and very short sentences (Wren, 1985). Words or structures divorced from dialogue, as in the previous example, require high-level metalinguistic skills and thus are difficult for a child with LI. Other tasks, such as sentence repetition, sentence completion, and judgment of grammaticality, are unreliable and should not be used without a spontaneous conversational sample (Fujiki & Willbrand, 1982). Yet, even though the more open-ended conversation may be more representative, it is usually less intelligible and may be difficult for some children with LI. For example, children with LD exhibit as much difficulty with conversations as with other assessment protocols (Donahue, 1984; Roth, 1986). Although specific stimulus items may increase intelligibility by controlling the topics discussed, increased intelligibility may result in decreased productivity as mentioned. Further, the child may

Chapter 3

Assessment of Preschool and School-Age Children with Language Impairment


develop or already have a stereotypic pattern of responding to the item. For example, a doll may elicit a “baby talk” style. The items chosen and the directions given also may affect the validity of the sample. For example, pictures can be used to elicit language, but the instructions given to a child often affect the quantity of language produced. The directive “Tell me about this picture” elicits less language than a more directive style (Wren, 1985), such as the following: I’d like you to make up a story from this picture. I want you to tell me a whole story that has a beginning and an end. Start with “Once upon a time” and tell me the whole story. The best advice for any SLP is to remain flexible in order to shift between different contexts and different content and to elicit the kinds of language behavior desired. An SLP should have a variety of stimulus materials and be skillful in discussing a range of topics potentially interesting to a child (Shriberg & Kwiatkowski, 1985). SU M MARY Descriptive approaches are not without problems. Although they are potentially more representative of a child’s everyday performance than formal testing, this potential is not guaranteed. In addition, descriptive approaches require that an SLP have considerable knowledge of language and of the variables that affect children’s language performance. Skillful manipulation of these variables by an SLP can enhance the potential intervention value of descriptive methods.

An Integrated Functional Assessment Strategy Speech-language professionals usually suggest a combined assessment approach (Kelly & Rice, 1986; Klein, 1984; McCauley & Swisher, 1984b). The purpose of the assessment should influence its design. Almost universally, SLPs would agree that no single measure or session is adequate (Emerick & Haynes, 1986). This allows for multiple assessment of language features and behaviors in a variety of relevant contexts. The SLP must consider the following seven variables in designing and implementing the assessment process (Kelly & Rice, 1986): 1. 2. 3. 4. 5. 6. 7.

Child’s chronological and functional age State of child’s sensory system (vision, hearing, etc.) Caregiver concerns Status of child’s psychological functioning Child’s interests and materials available Child’s activity level Child’s attention span

Judicious manipulation of some of these variables facilitates elicitation of a representative sample. In general, alternation of structured and less structured tasks keeps a child’s attention by providing variety. The SLP readily adapts the methods to each child and is mindful that children will respond differently to different adults.


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A combined or integrated assessment approach provides the most thorough individualized method of evaluation and includes a questionnaire and/or caregiver interview, an environmental observation, an SLP-directed formal psychometric assessment, and a child-directed informal assessment consisting of a conversational sample from the child. The actual components will differ with each child. Each component is discussed in the remainder of this chapter. At each diagnostic step, objectives should be derived from the information collected to this point. Thus, each step becomes more focused, and the possible language problems are highlighted. Figure 3.3 presents a possible stage process of collecting data. At each stage, the process becomes more focused. The following discussion deals with a number of assessment steps, both formal and informal, that are aspects of an overall integrated functional model. QU ESTION NAI R E, I NTE RVI EW, AN D R E FE R RAL Caregivers—parents, teachers, and others—are central to a functional assessment and intervention process (Kelly & Rice, 1986). Teachers can be a valuable referral source and should be encouraged to be alert for children with potential language problems. Parents can also be effective referral sources for children with more severe LI; however, they are less reliable in identifying mild impairment (ContiRamsden, Simkin, & Pickles, 2006). This is true even for children with SLI who, by definition, lack other obvious disabilities. Initial caregiver involvement helps build rapport, increases the validity of the assessment results, and introduces the caregivers to the intervention process. A caregiver interview or questionnaire can be a valuable source of initial information on client functioning and on the perceived problem from the caregiver’s perspective. Caregiver expectations for a child also provide an indication of a caregiver’s willingness and perceived need to work with the child. Caregivers should be encouraged to ask questions and to participate fully.

Questionnaire, Interview, and Referral


Formal Testing

Conversational Language Sampling

At each stage, data suggest a further delineation of the possible language impairment. In the next stage, the possible impairment can be more sharply defined. FIGURE 3.3 A model of the assessment process.

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Assessment of Preschool and School-Age Children with Language Impairment


With very young children, caregivers can be a source of information for difficult-to-test behaviors. For example, vocabulary checklists completed by parents correlate well with other measures of vocabulary (Bates, Bretherton, & Snyder, 1988; Beeghly, Jernberg, & Burrows, 1989; Dale, 1991; Dale, Bates, Reznick, & Morisset, 1989). In fact, parental reports on the size of their 2-year-olds’ vocabulary correlate well with the results of language screening tests (Klee, Carson, Gavin, Hall, Kent, & Reece, 1998). In other areas of oral language, such as intelligibility, parents are less accurate (Kwiatkowski & Shriberg, 1992). In face-to-face interviews it is best to ask questions of caregivers in a straightforward manner, with no hesitation that might signal embarrassment or discomfort. The SLP avoids tag questions (e.g.,“You don’t . . . , do you?”) that seek agreement, rather than confirmation or information. Responses are treated matter-of-factly with little comment that might discourage a caregiver from talking. The SLP will be interested in the child’s prenatal, perinatal, and postnatal medical history, family medical and educational history, the child’s educational and social history, and descriptions of the child’s behavior. A list of possible language questions is presented in Table 3.3. Caregiver responses are analyzed and hypotheses are formed before deciding on the strategy for the remainder of the assessment. Potential language problems are researched thoroughly. OB SE RVATION To gain the most natural interaction, an SLP will want to observe caregiver(s) and peer(s) with the child as conversational partners in such everyday settings as the home and the classroom. In the classroom, an SLP might observe the child participating in a number of activities. This situation is not always possible. Time may not permit observation alone. In this case, an SLP may wish to observe closely while collecting a language sample and may form tentative hypotheses for later confirmation from the analyzed sample. If observation occurs in a more clinical setting, appropriate toys and both structured and nonstructured activities are provided for the child and conversational partner. Caregivers are encouraged to use familiar objects and the child’s favorite toys or objects from home or the classroom. Ideally, the SLP would observe the child’s behavior with various communication partners. The SLP instructs caregivers to interact as typically as possible with the child. It is essential that caregivers not quiz or direct the child to perform during the observation. Optimum performance is attained if the SLP unobtrusively remains in the room or leaves and observes from outside via observation windows or video monitors. The style of interaction is more than just the frequency of various forms of behavior. More important are the ways in which a child uses the various features of his or her linguistic interactional style. The key question is, How does the child interact with others? Routinized situations may provide a child with a scaffold or frame within which language processing becomes automatized (Lieven, 1984). The SLP needs to assess the child’s familiarity with the situation and the degree to which that situation provides a prop for the child’s language. Atypical situations will not elicit typical performance. Although atypical situations may be useful vehicles for enhancing some children’s language performance, they can also suppress it and will not usually yield a representative sample of a child’s language. For most, but not all, children, play with familiar toys is a typical activity. The INREAL/Outreach Program of the University of Colorado recommends an observation strategy called SOUL. The acronym stands for silence, observation, understanding, and listening. The adult remains silent for periods of time, assessing the situation before talking. Observation of a child’s play


Interview or Questionnaire Format

Questions relative to language uses: How does the child let you know items desired? What does the child request most frequently? What does the child do when requesting that you do something? When wanting you to pay attention? When wanting something? When wanting to direct your attention? Does the child ask for information? How does the child express emotion or tell about feelings? What emotions does the child express? Does the child make noises when playing alone? Does the child engage in monologues while playing? Does the child prefer to play alone or with others? Does the child describe things in the environment? How? Does the child discuss events in the past, future, or outside of the immediate context? Questions relative to conversational skill: When does the child communicate best? How does the child respond when you say something? How does the child respond to others? Does the child interact more readily with certain people and in certain situations, and if so, with whom and when? With whom and when does the child communicate most frequently? Does the child initiate conversations or activities with you and with others? What is the child’s most frequent topic? Does the child join in when others initiate conversations or activities? Does the child get your attention before saying something to you? How does the child do this? Does the child maintain eye contact while talking to you? Does the child take turns when talking? Does the child interrupt? Are there long gaps between your utterances and the child’s responses? Will the child take a turn without being instructed to do so or without being asked a question? When the child speaks to you, is there an expectation of a response? What does the child do if you do not respond? When the child responds to you, does the response usually match or is it relevant to what you said? How does the child ask for clarification? How frequently does this occur? If you ask the child for more information or for clarification, what happens? Does the child demonstrate frustration when not understood? When the child asks for or tells you something, is there usually enough information for you to understand? When the child tells you more complex information or relates an event or a story, is it organized enough for you to follow the train of thought? Does the child have different ways of talking to different people, such as adults and small children? Does the child phrase things in different ways with different listeners? Is the child more polite in some situations? Does the child seem confused at times? What does the child do if confused? Questions relative to form and content: Is the child able to understand simple directions? Does the child know the names of common events, objects, and people in the environment? What types of information does the child provide about these (actions, objects, people, descriptions, locations, causation, functions, etc.)? Does the child seem to rely on gestures, sounds, or the immediate environment to be understood? Does the child speak in single words, phrases, or sentences? How long is a typical utterance? Does the child leave out words? Are the child’s sentences complex or simple? How does the child ask questions? Does the child use pronouns and articles to distinguish old and new information? Does the child use words for time, such as tomorrow, yesterday, or last night? Does the child use verb tenses? Can the child put several sentences together to form complex descriptions and explanations? Source: Compiled from Brinton & Fujiki (1989); Lund & Duchan (1993); and Spinelli & Terrell (1984).

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Assessment of Preschool and School-Age Children with Language Impairment


and interactions with other people occurs prior to forming hypotheses. Understanding is the insight into a child that comes from the distillation of data collected during observation. Finally, listening requires total involvement by an adult and the use of responses appropriate to the functioning level of the child. The SLP obtains from the caregiver interview some notion of what to observe. Reliability of observation is increased if the SLP’s descriptions detail as closely as possible the actual observed behavior. Inferences and hypotheses come later. It is best if the observation is taped or digitally recorded for later referral. Handheld computers also have been shown to be an effective and reliable way to collect language data in situations where it is used, such as in the classroom (Olswang, Svennson, Coggins, Beilinson, & Donaldson 2006). Table 3.4 is a list of some features that an SLP might observe. This list is not exhaustive. Each category is discussed in some detail in Chapters 6 and 7, where we consider the analysis of a conversational sample. The purpose of observation is to note within the larger scope of interaction the language characteristics to be tested, collected, and analyzed later in the assessment. Reliability of observation is not fortuitous. SLPs should train together thoroughly so that their observations are as accurate and as objective as possible. This accuracy and objectivity can be accomplished by repeated observation and rating of recorded samples by more than one SLP. Ratings then can be compared, discussed, and modified in light of reexamination of the samples. FOR MAL TESTI NG Within an evaluation session or sessions, a change to more formal testing tasks might be accomplished through the use of a nonthreatening receptive task, possibly one requiring only a pointing response. Such a task allows a child to become accustomed to an SLP’s direction. An annotated list of several current tests is presented in Table 3.5.


Features to Note While Observing the Child

Form of language. Does the child use single words, phrases, or sentences primarily? Are the sentences of the subject-verb-object form exclusively? Are there mature negatives, interrogatives, and passive sentences? Does the child elaborate the noun or verb phrase? Is there evidence of embedding and conjoining? Understanding of semantic intent. Does the child respond appropriately to the various question forms (what, where, who, when, why, how)? Does the child confuse words from different semantic classes? Language use. Does the child display a range of illocutionary functions, such as asking for information, help, and objects; replying; making statements; providing information? Does the child take conversational turns? Does the child introduce topics and maintain them through several turns? Does the child signal the status of the communication and make repairs? Rate of speaking. Is the rate inordinately slow or fast? Are there noticeable or lengthy pauses between the caregiver and child’s turn? Are there noticeable or lengthy pauses between the child’s adjacent utterances? Does the child use fillers frequently or pause before producing certain words? Are there frequent word substitutions? Sequencing. Does the child relate events in a sequential fashion based on the order of occurrence? Can the child discuss the recent past or recount stories?


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Helpful Hints for Language Testing




Carrow Elicited Language Inventory (Carrow, 1974)

Consists of 52 sentences that the child repeats Contains scoring/analysis form and verb protocol Ages 3 to 7-11

One of only a few tests that are normed for 3-year-olds. It scores the number or errors rather than the number of correct responses. The norms are tricky, because older children tend to modify the sentences to make them conform more closely to speech, e.g., substituting “doesn’t” for “does not.” Test should be audio-recorded for accuracy in scoring, but you can gain a quick idea of a child’s performance by marking each sentence as the child repeats it. The total errors can be quickly counted for an approximate error score. While easy to administer and a bear to score, the analysis yields vital information on language form.

Comprehensive Receptive and Expressive Vocabulary Test, 2nd edition (Wallace & Hammill, 2002)

Test of receptive and expressive vocabulary via pointing to pictures named and providing definitions Ages 4 to 89-11

Expressive vocabulary definitions are sometimes unusual when testing children with LI. Be prepared to have to interpret whether a response is correct or incorrect, even though the developers have tried mightily to anticipate responses. My favorite wrong answer for cider was “Her lunch was inside her.

Fullerton Language Test for Adolescents, 2nd edition (Thorum, 1986)

Overall language test with Very difficult adolescent test. subtests in syntax, morphology, I question the value of the semantics, and syllabication Syllabication subtest for students Ages 11 to adult. of this age. The Morphology Competency subtest is extremely difficult to score because the examiner must decide on the correctness of the response with very little guidance.

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Assessment of Preschool and School-Age Children with Language Impairment


TABLE ) TABLE 3.5 3.5 ( continued Helpful Hints for Language Testing Test



Peabody Picture Vocabulary Test, 4th edition (PPVT) (Dunn & Dunn, 2007)

Child or adult points to one of four pictures named Ages 2–6 to 89–11

Be careful not to overextrapolate from the results. The test, despite its claims, merely measures a client’s ability to match a picture with a name. It tells us nothing about depth of understanding or definitions. Nouns are overrepresented despite that this type of word becomes a smaller portion of our lexicons as we mature.

Test of Adolescent and Adult Language, 4th edition (Hammill, Brown, Larsen, & Wiederholt, 2007)

Overall language test with subtests in written and spoken language in syntax and semantics Individual or group administration Ages 12 to 24-11

Good general test; easier than the Fullerton. Sentence Combination subtest will be very difficult for clients with auditory working memory problems. Spoken Analogies subtest is related more to cognitive abilities than language abilities.

Test of Auditory Comprehension of Language, 3rd edition (TACL-3) (Carrow-Woolfolk, 1999)

Consists of three subtests: Vocabulary, Grammatical Morphemes, and Elaborated Phrases and Sentences Ages 3 to 9-11

Often a child will pass the first two subtests but fail the third. This occurs with children who have language form difficulties and/or auditory memory problems. Norms are available by subtest, so to shorten the test, you might wish to give only this subtest. Extremely distractible children may need to be reminded to look at all the pictures. Although this violates test norms, remember that the test was not normed on children who are other than typical. Report your findings, and note that this score was only attainable with reminders to stay on task. (After all, are we measuring language or distractibility?)



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Communication Assessment

TABLE ) TABLE 3.5 3.5 ( continued Helpful Hints for Language Testing Test



Test of Language Development–Intermediate, 4th edition (Hammill & Newcomer, 2007)

General language test with several subtests covering semantics, morphology, and syntax Ages 8 to 17-11

Good overall test. Some of the two-word descriptors used in the picture vocabulary subtest are unnecessarily difficult. The Word Ordering subtest will be especially difficult for children with poor auditory working memory. While the task is fun to do, I question its relevance to the real world. When was the last time someone approached you and said, “Party fun was the”? The Malapropisms subtest is fun to give as long as you don’t fall over the errors and give them away, but again I’m not positive of its relevancy.

Test of Narrative Language (Gillam & Pearson, 2004)

Assesses narrative skill in three modes: no pictures, single pictures and sequential pictures Assesses both literal and inferential comprehension Ages 5 to 11-11

Good overall measure of an area that may be difficult to assess through sampling and is difficult to analyze. Systematic data collection method.

Word Test Elementary, 2nd edition & Word Test Adolescent, 2nd edition (Bowers, Huisingh, LoGiudice, & Orman, 2004)

Comprehensive test of word associations, synonyms, semantic absurdities, antonyms, definitions, and flexible word use Ages 6 to 11-11 & 12+

Thorough evaluation of the mental mapping networks in which words are stored. The adolescent test is greatly improved over the previous edition. The developers have done a nice job of anticipating responses to the definition subtests. You’ll still receive some weird ones.

Assessing All Aspects of Language It is important that the SLP make a thorough assessment of all aspects of language. Only rarely is a language impairment limited to one aspect alone. Should this be the case, however, as with a highfunctioning child with TBI who manifests only lingering pragmatic difficulties, testing of all aspects confirms the absence of problems and provides a holistic image of the child’s language. This task may necessitate more than one session with the child and caregivers. Even when problems in a single area, such as vocabulary, are suspected, more than a single test should be used in order to best describe the

Chapter 3

Assessment of Preschool and School-Age Children with Language Impairment


language deficit (Grey, Plante, Vance, & Henrichsen, 1999). Issues relative to each aspect of language are discussed in the following section. Pragmatics. Very few tests are available that assess a child’s conversational skills. In general, the tests are of two varieties—storytelling and topic discussion. In both test situations, the essential feature of conversational relevance is strained, and it is doubtful that a true description of a child’s abilities is attained. For example, the topic discussion format makes it difficult to assess question comprehension (Moeller, Osberger, & Eccarius, 1986). As a result, questioning is sampled inadequately, restricted in type, and lacking in variation of communicative contexts (Parnell & Amerman, 1983). The nature of pragmatics makes formal testing difficult. It is also difficult to establish reliable norms, because such aspects of pragmatics as the amount of talking, the frequency of initiations, the type of discourse structure, and the register are situationally related. At present, it seems more appropriate to use a conversational sample to assess children’s language use. Semantics. Although children with LI have a range of semantic difficulties with acquisition, storage, and retrieval, most formal assessments are limited to receptive and expressive vocabulary. Few standardized tests assess multiple aspects of semantic knowledge. At the very least, we should be interested in word knowledge, novel word learning, word categories, figurative language, multiple meanings, and word-finding. When does an SLP know that a child has learned a word? Tests typically assume an all-ornothing phenomenon in which a child either does or does not know the meaning (Crais, 1990). In reality, acquisition of word knowledge is a gradual process that may continue through the lifetime of an individual. An individual child’s success or failure on a test item may be dependent on several factors, such as the type of task or the manner of cuing. Testing tasks are often contrived, out of context, and highly literate (Nippold, Scott, Norris, & Johnson, 1993). Testing of semantic abilities often is confined to picture identification, word definitions, and word categories. Of interest are a child’s comprehension and production vocabularies. Comprehension vocabulary usually is measured by having a child point to a picture that best represents the word produced by the test administrator. Such tests tell an SLP very little about the frequency of use or the depth or breadth of a child’s understanding of the concept named. Comprehension of longer utterances usually is assessed by having a child follow simple commands or directives. When a word is not fully understood by a child, he or she may rely on other comprehension strategies based on linguistic features, such as word order, or on nonlinguistic features, such as the position or size of stimulus items, such as pictures (Edmonston & Thane, 1992). During testing, an SLP should note behaviors such as locational preferences in pointing responses and verbal comments that accompany responding. Expressive or productive vocabulary usually is tested by having a child name pictures or supply a definition. Scoring may be of a correct-incorrect or scaled type. The latter allows for partially correct responses. Descriptions by the SLP of the type of definition given by a child can be valuable in determining the maturity of the child’s lexicon. Early definitions usually rely on use. These are followed in order by descriptions, use in context, synonyms and explanations, and finally, conventional definitions (Curtis, 1987). The entire process takes years to accomplish. The Diagnostic Evaluation of Language Variance (Seymore, Roeper, & deVilliers, 2003), a criterionreferenced tool, includes a subtest of novel word learning. SLPs also may wish to develop their own evaluative instruments (Brackenbury & Pye, 2005). For example, incidental learning can be examined using


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either unknown words or nonsense words within contexts in which the referent or entity referred to is present but not directly defined. Follow-up testing can determine if the word was learned. A number of factors, such as word length, syllable structure, and familiarity of consonant clusters, influence phonological working memory, where words are held while processed. For this reason, it seems unwise for an SLP to design informal measures of phonological form storage unless she or he has researched this area thoroughly (Brackenbury & Pye, 2005). Typically, phonological storage and processing are assessed through nonword repetition tasks such as those found in the Children’s Test of Nonword Repetition (Gathercole & Baddeley, 1996). Several assessment instruments have subtests of semantic categories and connectors between words. Sorting and labeling tasks can be used in informal assessment. Categorical understanding is assessed by asking the child to supply an antonym or a synonym or to name related words in a category. Between ages 5 and 9, children undergo a change in the organization of language, from a syntactic to a more categorical system. Thus, category membership and related words, not just simple word meaning, should be tested with all children in late elementary and high school. Word-association tasks such as naming another member of a category may be ineffectual in differentiating children with LI and those without (Kail & Leonard, 1986). Responses are dependent more on the familiarity of the category and the number of responses possible (Crais, 1990). Other semantic-related tasks include giving antonyms or synonyms, stating similarities and differences, telling all one knows about a word, detecting semantic absurdities, explaining figurative language, and noting multiple meanings. Each task requires different abilities, including determining the task demands, focusing on critical semantic dimensions, and interpreting cues, that can be complicated by word-retrieval difficulties. Children with LD or TBI exhibit word-finding and word-substitution difficulties. Little is known about word-retrieval processes. In children, the words substituted usually share some visual attributes with the target word referent, such as saying sheet for cape and net for screen. Late elementary school children with LD exhibit more visually related word-substitution errors than do TD children (German, 1982). Additional word-finding substitutions found in children with LD include functional descriptions, such as book holder for shelf. Diagnostically, use of these word-finding strategies indicates that a child comprehends the word but has difficulty retrieving it. Although testing may reveal a deficit in naming skills, such tests rarely indicate the nature of the deficit. Identification of the word-retrieval strategies of these children may aid in the design of remediation techniques directly related to these strategies. Word-finding difficulties can be assessed formally with measures such as the Test of Word Finding, Second Edition (TOWF-2) (German, 2000), and informally using a format similar to that used by the TOWF-2. It is important to distinguish between those words unknown to the child and those known but difficult to retrieve. Usually, the referents of unknown words cannot be identified by a child through pointing when their names are presented. In contrast, if a child can identify referents receptively but not name them on a different occasion, word-retrieval problems may be present. In informal assessment, especially in severe cases, such as the initial stage of recovery from TBI, it may be useful to begin with common everyday objects and actions in the environment. One method for attaining more information from tests is a double-naming technique (FriedOken, 1987). In this procedure, a standard naming test is administered twice. The results are examined to identify error response groups that occur once and twice. The errors that occur on both administrations require further analysis.

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Assessment of Preschool and School-Age Children with Language Impairment


The SLP can administer a number of cues with the double-error words to determine whether the errors indicate word-finding difficulties and to identify naming strategies. In this procedure, cues are administrated in the following order (Fried-Oken, 1987): 1. General question. The child is asked a general, open-ended question, such as, “Can you think of another word for this?” or “What is this again?” that provides no additional linguistic information. 2. Semantic/phonemic facilitator. Two cues, based on additional semantic and phonemic information, are administered. The order of presentation varies, but the SLP should record carefully the order and the response. The semantic cue describes the object’s function, provides a categorical label or states the location. For example, if the picture shows a sofa, the SLP might say,“It’s something you sit on,”“It’s a piece of furniture,” or “You find it in the living room.” The child’s response and the type of semantic prompt should be noted. The phonemic cue includes the initial phoneme of the desired label (“The word starts with a /_/.”) This type of cue requires certain metalinguistic skills of a child in order to use the information given. 3. Verification. If a child is still incorrect, the SLP provides the correct label and asks whether the child has ever seen this object before in order to verify whether the word is in the child’s repertoire. The child’s responses and the cues are analyzed to determine the qualitative nature of the errors and the child’s naming strategy. Possible naming strategies of 4- to 9-year-old children are listed in Table 3.6.


Naming Strategy Categories

Naming Strategy


Phonological Perceptual Semantic Semantic + perceptual

foon/SPOON lampshade/SKIRT tortoise/OCTOPUS broom/MOP shirt/JACKET shoelace/SHOE you can play songs/PIANO it has numbers and hands/CLOCK in a band/TAMBOURINE food/CRACKERS Shetland pony/HORSE canoe/HARMONICA canoe/MUSHROOM I don’t know/GLOVE 10+ seconds of silence/MITTEN “strumming”/GUITAR

Part/whole Functional circumlocution Descriptive circumlocution Contextual circumlocution Superordinate Subordinate Unrelated perseveration Comment No answer Gesture

Source: Reprinted with permission from Qualitative examination of children’s naming skills through test adaptations by M. Fried-Oken. Language, Speech, and Hearing Services in Schools, 18, 206–216. Copyright © 1987 by American Speech-Language-Hearing Association. All rights reserved.


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Syntax Syntactic testing can be extremely complicated because of the complexity and diversity of the syntactic system. SLPs may wish to use entire test batteries or portions of several tests. The latter strategy is recommended for in-depth probing of potential problem areas. Naturally, when tests are used in a nonstandard manner or are combined with other subtests, the norms can no longer be used. Results must be described accurately and interpreted in light of the tasks involved. There is considerable variability across tests in the length of individual syntactic items, the structures tested, and the type of testing tasks used. Test tasks are as diverse as highly unnatural ones, such as word ordering or unscrambling and sentence assembling, and more natural tasks such as sentence combining (Nippold et al., 1993). Many mirror the highly decontextualized tasks found in school, such as fill-in-the-blank, but do not reflect everyday language use. In general, development of comprehension of syntactic forms typically precedes production. Thus, a thorough language assessment should include evaluation of both aspects. Although the receptive procedures used and the structures assessed vary widely across tests, the common element is that a child demonstrates understanding—usually by pointing to a picture or following directions—while producing only minimal language, if any. Syntactic production typically is tested by using either a structured elicitation or a sentence imitation format. In structured elicitation, a child might be asked to describe a picture, following a model by the test administrator. The model sentence establishes the sentence form to be used (she is running) but differs from the desired sentence by the structure being tested (she will run). In sentence imitation, a child gives an immediate repetition of the test administrator’s sentence. The underlying assumption of elicited imitation procedures is that sentences that exceed a child’s working memory will be reproduced according to a child’s own linguistic rule system, which the child must use as a processing aid. Theoretically, the child’s sentence should be very similar to the one the child would produce spontaneously. Thus, the child’s imitated sentence should not contain any structures absent in the child’s spontaneous language production. Although elicited imitation serves as the basis of a number of diagnostic instruments and as a portion of several other tools, the validity of the procedure has been questioned frequently. Although the performance of children with LI on elicited imitation tests can be enhanced by the addition of contextual cues, such as pictures or object manipulation, their imitations are still simpler than their spontaneous language production. Assumptions about the performance of TD children may not apply to children with LI. Because the relationship between elicited imitation and spontaneously produced language is a very complex one, SLPs are advised to use elicited imitation results with caution and to rely on the data from spontaneous samples when the two differ (Fujiki & Brinton, 1987). Elicited imitation responses should be analyzed for the specific ways they differ from the model. Table 3.7 on pages 96–97 provides a method of scoring sentence imitation tasks that maximizes the available information for clinical use (Mattes, 1982). Each response is scored for grammatical acceptability, type of syntactic error, semantic equivalence, and quality of response. Such analysis is much richer than simple correct/incorrect scoring. Morphology Morphological testing usually focuses on bound inflectional morphemes. Most tests emphasize suffixes, such as tense markers, plurals, possessives, and comparators, because of their high usage and relatively early development. In general, children with good spoken and written language abilities have more morphological awareness and do better on such tests (R. C. Anderson & Davison, 1988; Bailet, 1990; Fisher, Shankweiler, & Liberman, 1985; Liberman, Rubin, Duques, & Carlisle, 1985; Nagy, Anderson, Schommer, Scott, & Stallman, 1989; Snow, 1990).

Chapter 3

Assessment of Preschool and School-Age Children with Language Impairment


Suffixes can be divided into two types: inflectional and derivational. Inflectional suffixes indicate possession, gender, and number in nouns; tense, voice, person and number, and mood in verbs; and comparison in adjectives and do not change the part of speech of the base. For example, a noun can be made plural with the addition of the -s marker, but the noun remains a noun. The second, larger category, derivational suffixes, is ignored in most tests. Derivational suffixes have a smaller range of application and many more constraints and irregularities than inflectional suffixes. Application may be unpredictable, as with -tion, which can be added to some but not all nouns. Also, the meaning can be somewhat unclear, as with -ment in apartment. More than 80 percent of multimorpheme words do not mean what the constituent parts suggest (White, Power, & White, 1989). The development of derivational suffixes is not as clearly understood as that of inflectional suffixes but seems related to oral language production abilities, reading level and exposure, derivational complexity, and metalinguistic awareness (Carlisle, 1988; Fisher et al., 1985; Nagy, Anderson, & Herman, 1987; Nagy, Herman, & Anderson, 1985; Tyler & Nagy, 1987; Wysocki & Jenkins, 1987). The two most common expressive test formats for morphology are cloze, or sentence completion, and sentence imitation. Most cloze procedure test items give the root word and require the child to respond with the root plus a suffix, as in teach and teacher. Tests use either actual words or nonsense words. The rationale for nonsense words is that their use will not bias performance by previous exposure. In general, tests using nonsense words are more difficult for young children (Channell & Ford, 1991). Children with either MR or LLD have greater difficulty with nonsense word tests than children developing typically. Other testing tasks might include judgments of relatedness of words, such as hospital and hospitable, ability to deduce meaning from component parts, and ability to form words in different and changing linguistic contexts (Moats & Smith, 1992). Although several tests have morphological portions or subtests, most have too few items and too narrow a scope to provide much valuable information (Moats & Smith, 1992). Prefixes and derivational suffixes are included on only a few tests. Written Language A written sample should also be collected, especially if dyslexia or LD is suspected. It should include first drafts of expository writing, narrative fiction, and nonfiction. The SLP can evaluate the sample for phonological and linguistic awareness; word boundaries; vocabulary and usage; ability to communicate thoughts precisely, sequentially, and systematically; generation and organization of ideas; morpheme usage; syntactic usage, semantic awareness, and word associations, such as opposites and synonyms; and handwriting (Greene, 1996). This area of assessment will be discussed in detail in Chapter 13. Test Modification As mentioned previously, tests can be modified to provide the information desired by an SLP. For example, an SLP may wish to test a child’s pronoun use in depth. No test is available that adequately assesses only these structures. An SLP might construct his or her own assessment tool from portions of other tests. I’ve listed several tests, with modifications and comments on use, in Table 3.8. This type of locally prepared test may be very useful for thorough assessment. Obviously, individual test standards of administration have been violated and the norms would be invalid. Occasionally, published tests include subtest norms. In this case, a subtest on pronouns may be administered in its entirety as directed in the instructions, and the norming information would be applicable. Test administration may be modified also for the child who cannot perform as required or for further investigation of the child’s response strategies. For example, use of pictures or repetition of


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Elicited Language Analysis Procedures Format

Student’s Name: Birthdate: _______________ Examiner: ______________________________ Test Date: _________________

Instructions: Record the child’s responses in the spaces below. Score responses in terms of grammatical acceptability, syntactic usage, vocabulary usage, and response quality by placing a check mark in the boxes that most accurately describe the response.


Response Quality Comments

Grammatical Acceptability Correct: Identical Correct: Nonidentical Substitution Error Deletion Error Insertion Error Modification Error Word Sequence Error Non-Attempt Error Equivalent in Meaning Related in Meaning Unrelated in Meaning Delayed Response Self-Corrected Response Perseverative Response

Test Item #

Syntactic Usage on Structure Tested

The child’s elicited imitation is written in the appropriate column at the left. Omissions, substitutions, changes in meaning and the like are noted by marking the appropriate column. The errors and target structures can be recorded under the Comments column, such as “Omit past-tense -ed” or “Change passive voice to active.” Such analysis may help delineate unlearned structures and the cognitive-linguistic knowledge base. Response Categories Grammatical acceptability. Child’s response is a complete and grammatically correct sentence. Syntactic usage on structure tested. The manner in which the grammatical structure tested is produced. A. Correct production: identical sentence frame. Child’s response is an identical word-for-word reproduction of the model. B. Correct production; nonidentical sentence frame. The grammatical structure being tested is produced correctly, although the sentence frame differs from the model. C. Substitution error. The child substitutes an inappropriate grammatical form for the structure being tested. D. Deletion error. The child inappropriately omits the grammatical structure being tested. E. Insertion error. The child inserts the grammatical structure being tested within a sentence frame where it is inappropriate. F. Modification error. The child produces a modification of the grammatical structure being tested that is not acceptable in any context (e.g., him’s, ain’t, it’s is). G. Word sequence error. The child produces the grammatical structure being tested in an appropriate position within the response. H. Non-attempt error. Performance cannot be evaluated (e.g., I don’t know).

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Assessment of Preschool and School-Age Children with Language Impairment


Vocabulary usage. Manner in which the child’s response relates semantically to the stimulus sentence. A. Equivalent in meaning. Although the specific vocabulary used by the child is not identical to the model, the response is identical in meaning. B. Related in meaning. The child produces a response that is partially related to the meaning of the model. The child may omit essential elements or modify vocabulary. C. Unrelated in meaning. The child produces a nonmeaningful response or one that is unrelated to the model. Response quality A. Delayed correct response. The child produces a correct response that is nonimmediate, requires a repetition of the model, or is produced after hesitation during response. B. Self-corrected response. The child self-corrects an incorrect response without prompting by the examiner. C. Perseverative response. The child produces a response that resembles that used on a previous test item but that is inappropriate for this item. Source: Reprinted with permission from The elicited language analysis procedure: A method for scoring sentence imitation tasks by L. Mattes. Language, Speech, and Hearing Services in Schools, 13, 37–41. Copyright © 1982 by American Speech-Language-Hearing Association. All rights reserved.

instructions may enhance the performance of some children. It is important to remember that nearly all tests are designed for TD children. The child with MR or cerebral palsy is at a very distinct disadvantage. In such cases, description of a child’s ability when procedures are modified may be much more useful for intervention than a score. Adherence to prescribed test procedures is more likely to result in a measure of that child’s limitations. Testing procedures may be modified through the use of multiple sessions, increased time to respond, and increased trials. For children with attentional difficulties, an SLP might enlarge materials, use a penlight or pointer, highlight certain information, verbally remind the child to attend, or have the child repeat the test cue prior to responding. The performance of children with motor problems, ASD, or LD might be affected also by visual or auditory distractions, placement of materials, temperature, lighting, light and dark contrasts, and positioning. Children who perseverate may need to be reminded that the correct answer for one item is not the same for another. Children with memory problems may need to have cues repeated, to repeat cues aloud themselves, or to have cues broken into easily processible units. Finally, children with TBI may need a longer time to respond. The SLP also should test beyond base and ceiling scores to identify “islands” of learning. Other modifications for children with TBI may include reduction of distractions, different response modes, enlarged print and reduction of print per page, simplified instructions, substituting multiple choice questions to facilitate recall, giving multiple examples, providing breaks when fatigue is evident, and darkening lines or print in visual displays (Russell, 1993). SAM PLI NG Conversational sampling has the potential for providing the most accurate description of the child’s language as it is actually used in conversational exchange. Although sampling usually includes freeplay and unstructured conversation, it also may include structured conversation and probing of language


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features noted in observation and testing. In the next several chapters, we discuss the best ways to maximize the information from this source through design of collection situations and analysis methods.

Assessment for Information-Processing Deficits As mentioned in Chapter 2, children with a variety of disorders exhibit difficulty processing verbal information. Although questions about cognitive functioning should be answered by a team that includes at least a neurologist, a psychologist, and an SLP, probing by the SLP can answer some questions and suggest alternative methods of intervention. Standardized testing will provide some insight but is no substitute for comprehension and production of language in real-life contexts. Of most importance are changes in performance under varying task demands. The SLP can assess a child’s performance by varying the speed of information using both familiar and unfamiliar words and structures (Ellis Weismer & Evans, 2002). Usually there is a tradeoff between accuracy and timing. The SLP can assess memory with a variety of inputs, both verbal and nonverbal (Montgomery, 2002a). These may include digit and word tasks and nonword repetition. The length of the units to be repeated can be varied in both number and unit size, such as number of syllables and their complexity. In the classroom, the SLP can observe and assess note taking and expository writing (see Chapter 13). The SLP can read sentences to the child and have the child combine them or answer questions about the content. Longer units can be read and the child asked to identify content in the beginning, middle, and end. Finally, the SLP should use the test-teach-retest form of dynamic assessment, the most ecologically sound manner for assessing cognitive functioning (Gillam et al., 2002). Discussed in more detail in Chapter 4, dynamic assessment is concerned with the child’s ability to learn rather than his or her level of past learning. For example, in the teaching phase, the child may be taught to identify the main idea in a paragraph or to interpret a comment, conversation, or narrative. In the retest phase, the SLP focuses on the kinds of change and the effort required. Of interest throughout are the child’s ability to attend, perceive, and recall information, understand explanations, relate past information to new, infer, and generalize.

Conclusion There is no one way to assess children with LI. A combination of interviewing, observation, testing, and sampling/probing offers a holistic approach that can incorporate not only the child but also significant others and familiar communication contexts. It’s important as you move through an assessment not to become too absorbed in the minutia of various isolated language features. This “forest for the trees” (N. W. Nelson, 1998) syndrome can result in missing the holistic nature of the child’s communication system. Once all the data is assembled, final analysis begins. More data may be needed. If collection can be characterized as somewhat scientific in its approach, analysis, while similar in nature, requires more of the artist in each SLP, as he or she paints an individual portrait of each child with LI. More of this in Chapters 5 through 8.



Assessment of Preschool and School-Age Children with Language Difference


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anguage differences, such as dialects or the influence of a first language on a second, are not disorders. Such differences are valid rule-governed linguistic systems in and of themselves. A child learning a nonstandard dialect of American English or learning American English as a second language may also exhibit language disorders, such as LD, SLI, or any of the others discussed in Chapter 2. The task for the SLP is to separate these natural differences from disorders. An increasing proportion of children in U.S. schools are culturally and linguistically diverse. Results of the 2000 U.S. census indicate that 18 percent of the population age 5 and greater, approximately 47 million people, speak a language other than English at home. Of these, approximately 21 million indicated that they didn’t speak English well (Shin & Bruno, 2003). These numbers includes many Latino Americans and Asian Americans and some Native Americans for whom English is a second language. In addition, a portion of working-class African Americans use African American English, a dialect of American English. Nationally, approximately 11 million children speak English as a second language. In New York state, more than 130 languages are represented in the schools (Heberle, 1992). In many large cities, more than 50 percent of the school population is children from culturally linguistically diverse (CLD) backgrounds. In general, these children have a greater dropout rate, are less successful in school, are overrepresented in special education classes, and are underrepresented in programs for the gifted. The primary reason for children with limited English being referred for possible special education placement is difficulty with English (Damico, 1991b). Unfortunately, in the United States, children with CLD backgrounds often live in poverty. This status can be related to a higher incidence of teen pregnancy, poor prenatal care, drug and alcohol abuse, low birth weight, poor nutrition, childhood illness and injury, and communication disorders. In addition, the demographics of immigration have changed recently to include many more immigrants from economically poor countries with poorer educations and few of the high literacy skills demanded by the changing U.S. economy (Heberle, 1992). The differences are both linguistic and cultural. Within the CLD population is a continuum of proficiency in English (ASHA Position Paper, 1985), including bilingual English proficiency, limited English proficiency (LEP), and limited proficiency in both English and the first language. It is important that an SLP be able to distinguish between a disorder and a difference that is the result of interaction of the native language and English. SLPs must appreciate the rule-governed nature of native languages and know their contrastive features. Elective speech and language services may be provided to individuals who are bilingual English proficient and who desire more standard production of English. It is important for an SLP to remember, however, that dialects of English that reflect the influence of the native language on English are not disorders. Individuals who are limited English proficient (LEP) are proficient in their native language but not in English. Assessment and intervention should be conducted in the native language as mandated by federal law (PL 94-142 and PL 95-561), legal decisions (Diana v. Board of Education, 1970; Lau v. Nichols, 1974; and Larry P. v. Riles, 1972), and state educational regulations. Adequate service delivery by an SLP requires native or near-native fluency in both languages and ability to describe speech and language acquisition in both languages, to administer and interpret formal and informal assessment procedures, to apply intervention strategies in minority language, and to recognize cultural factors that affect service delivery to the CLD community (ASHA Position Paper, 1985). For the remainder of the text, we shall use the term LEP to refer to children learning English as their second language. Other children will be specified as needed. Finally, those with limited proficiency in both English and the native language are truly communicatively handicapped. Language testing should establish language dominance and the most appropriate language for intervention (ASHA Position Paper, 1985). One error often made by inexperienced

Chapter 4

Assessment of Preschool and School-Age Children with Language Difference


SLPs is to assume that the native language (L1) is dominant. Young children may lose L1 as they begin to acquire a second language (L2), which in this case is American English.

State of Service Delivery Although the demographics of the United States are changing, the overwhelming majority of SLPs will continue to belong to the majority culture for the foreseeable future (Shewan, 1988). Approximately one in three SLPs has some bilingual clients, but more than 80 percent of these professionals do not feel confident in their abilities to serve these clients (Shewan & Malm, 1989; Taylor, 1989). It’s estimated that only 2 percent of certified members of ASHA are able to provide services in languages other than English (Langdon & Cheng, 2002). Inadequacies include a lack of academic preparation and experience, unfamiliarity with the language and/or culture, and a lack of appropriate assessment tools (Adler, 1991).

LACK OF PR E PARATION AN D EXPE R I E NCE Most academic programs offer little preparation for working with children with CLD backgrounds through either coursework or practicum. Until this deficiency changes, it is the responsibility of each SLP to educate him- or herself through continuing education. The following are some ways to interact more with culturally diverse populations: Work alongside a bilingual speech-language pathologist as an assistant. Take a foreign language course and/or a course in cultural diversity. Join cultural organizations and attend cultural festivals. Become a Big Brother or Big Sister or volunteer to work with culturally diverse youth. Volunteer in organizations such as Habitat for Humanity. Join organizations, such as National Coalition Builders Institute, that foster cooperation and understanding. Join church groups that foster interactions with inner-city churches. Go out of your way to introduce yourself to individuals from other cultures. Each SLP should remember that when he or she enters the environment of another cultural group, he or she is a guest and should act accordingly. Members of the majority culture sometimes expect members of minority cultures to accept them with open arms. My experience has been that there is a period of adjustment in which mutual trust is built. Only then does acceptance begin to grow.

U N FAM I LIAR ITY WITH LANG UAG E AN D CU LTU R E Becoming familiar with another culture and another language requires shedding many preconceived notions and becoming culturally aware. This requirement is followed by education about particular languages and cultures and about language development among CLD children. It is extremely difficult


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to become fluent in a second language as an adult or from classroom instruction. Therefore, one method for an SLP to use to overcome linguistic deficits is language interpreters. This alternative is discussed at the end of this section. Growth of Awareness All aspects of our lives are overlaid by culture. It affects our institutions and the way we act and think. Culture is a shared framework of meanings within which a population shapes its way of life. Culture is what one needs to know or believe to function in a manner acceptable to a particular group (Campbell & Champion, 1996). It is neither static nor absolute, but has been shaped by the population’s history and evolves as individuals constantly rework it and add new ideas and behaviors. It includes, but is not limited to, history and the explanation of natural phenomenon; societal roles; rules for interactions, decorum, and discipline; family structure; education; religious beliefs; standards of health, illness, hygiene, appearance, and dress; diet; perceptions of time and space; definitions of work and play; artistic and musical values, life expectations, and aspirations; and communication and language use. Culture interacts with language to influence cognitive and affective processes and the interpretation of behavior (Westby, 1995). Each culture has a unique outlook. It is essential for SLPs to recognize that culture is pervasive and diffused throughout their own lives. Culture forms the basis for their values and worldviews. Therefore, culture influences the way individuals view other cultures. SLPs from the majority culture in the United States typically have Euro-centered standards. These standards will influence each SLP’s decisions about LI, although these standards may not apply to individuals from other cultures. For example, Vietnamese culture is much more tolerant of speech and language diversity than is U.S. majority culture. Likewise, the Navajo culture values a quiet, introspective persona, which may seem withdrawn by U.S. majority standards. Language differences affect much more than language form, including rules for appropriate interaction in specific contexts, awareness of content information required in different situations, appropriate structures for participation, and communication styles (Westby, 1995) Words and concepts also are related culturally. For example, the word and the concept crib are not found in Korean. Table 4.1 offers other examples of cultural variants. Although SLPs cannot know all cultures, they can become increasingly culture sensitive. It is important to respect other cultures and to recognize that no one culture is the standard (N. Anderson, 1991). Cultural sensitivity requires not only recognition of one’s own culture but also examination of cultural notions held as “truths.” Many traditional notions of the U.S. majority culture, especially those involving poverty and ethnicity or race, are inappropriate in our global environment. The following are guidelines for interacting with clients from different cultures (Taylor, Payne, & Anderson, 1987): 1. Each encounter is a socially situated communicative event subject to cultural rules governing such events by both participants. 2. Children perform differently under differing conditions because of their unique cultural and linguistic backgrounds. 3. Different modes, channels, and functions of communication may evidence differing levels of linguistic and communicative performance.

Chapter 4


Assessment of Preschool and School-Age Children with Language Difference


Cultural Variants That May Influence Assessment


Other Cultures*

Majority U.S. Culture


Cooperation and group spirit. Accept status quo. Manual labor respected.

Emphasis on competition and success. Define self by accomplishments. To the victor go the spoils.


Elders are revered. Growing old is desirable.

Youth is valued.


Respectful, avoid eye contact, loudness for anger. Silence means boredom. Nonlinguistic and paralinguistic important.

Casual, direct eye contact, loud voice acceptable. Silence means attentiveness. Emphasize verbal.



Free will.


Formal for few. Entrance into mainstream society. Elders, peers, and siblings are teachers. Active, physical learning. Spontaneous, intuitive. Testing not integral.

Universal, formal, verbal. Key to social mobility. Teacher is authority. Classroom passivity rewarded. Reflective, analytical. Tests are part of learning.


Extended, kinship important, more varied, elder or parent centered. Male or female dominated.

Nuclear, small, contractual partnership, child centered.


Males independent, pampered. Females have many home responsibilities.

Relative equality.


Humility, anonymity, deference to group.

Individual makes own life. Stress self-reliance.


Excessive accumulation is bad, status ascribed.

Acquisition, symbol of success and power.

Social interaction

Contact, physical closeness. Kinship more important than friends.

Noncontact, large interpartner distance. Large group of friends desired.


Enjoy the present, can’t change future. Little concept of wasting time. Flexible.

Governed by clock and calendar, punctual, value speed, future oriented. Time is money. Scheduled.

*No specific culture. Source: Complied from Chamberlain & Medinos-Landurand (1991); Goldman & McDermott (1987).

4. Ethnographic techniques and cultural norms should be used for evaluating behavior and making determinations of LI. 5. Possible sources of conflict in assumptions and norms should be identified prior to an interaction and action taken to prevent them from occurring. 6. Learning about culture is ongoing and should result in constant reevaluation and revision of ideas and in greater sensitivity. This new awareness should lead to a recognition that “assessment is a subjective process that is highly influenced by the socio-political, cultural, and linguistic context” (Chamberlain & Medinos-


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Landurand, 1991, p. 112). In fact, to make sense of our behaviors, we must view them against the background of culture. Education in Language, Culture, and Language Development Sensitivity by SLPs is not enough. You must educate yourself about the dialects, languages, and cultures of the individuals you serve and about the process of dialect and second-language learning. Typically, SLPs make two common errors in evaluating the language of children with CLD backgrounds. Either children are identified incorrectly as having a language disorder, or those with a disorder are missed. For example, African American children from rural Alabama who speak the African American English dialect common to that area continue to delete final consonants beyond the age at which middle-class European American children do (Haynes & Moran, 1989). An SLP who is unaware of this difference might conclude, incorrectly, that these children exhibit a disorder. Cultures The breadth of cultural diversity is beyond the scope of this text. Suffice it to say that each SLP should become familiar with the cultures that he or she serves. Reading and observation are both essential methods of learning. An SLP must remember that cultures are not monolithic and that there is much heterogeneity, especially in the Latino American population. The need for professionals to understand and appreciate the beliefs and values of families from CLD backgrounds is critical. One study found that both parents and Head Start staff were unaware of their differing assumptions about education, parenting, child learning, and disability (Hwa-Froelich & Westby, 2003). Of particular importance are differences in child-rearing practices, family structure, attitudes toward LI and intervention, and communication style. Variants of communication style include nonlinguistic and paralinguistic characteristics, such as eye contact, facial expression, gestures and intenation; intercommunicant space and the use of silence and laughter; pragmatic aspects, such as roles, politeness and forms of address, interruption rules, turn taking, greeting and salutations, the ordering of conversational events, and appropriate topics; and the use of humor (Fasold, 1990; SavilleTroike, 1986; Taylor, 1986b). It is best if an SLP is somewhat cautious at first, until he or she has a sense of cultural expectations. Cultures differ in their beliefs about health, disability, and causation. A great deal of discomfort may surround disorder and intervention. Some families will be surprised by the extent of their expected role in intervention. Dialects and Second-Language Learning It is not possible to learn all of the dialects or languages one might encounter, especially in large metropolitan areas. Therefore, each SLP should attempt to learn the contrastive influences between other languages and dialects of children being served and Standard American English. Common phonological, syntactic, and morphological contrasts are found in Appendix A. SLPs can also learn high-usage words and forms of greeting in the language served. Not all children with different dialects are the same. Each child’s language will differ with the specific dialect spoken and the maturity of language and dialect development. Although data are limited, we know that children learning African American English, the dialect spoken by some inner-city and Southern rural African Americans, show only minimal evidences of their dialect by age 3. Earlier development is closer to the middle-class standard. By age 5, however, most African American English forms are being used, at least in part.

Chapter 4

Assessment of Preschool and School-Age Children with Language Difference


It is important for an SLP to remember that the range and frequency of dialectal forms will vary across children (Washington & Craig, 1994). Awareness and discrimination of dialects appear to increase slowly throughout elementary school while actual production gradually shifts to more standard use (Isaacs, 1996). Interestingly, speaking a minority dialect does not influence the ability to comprehend the majority dialect. Children in the United States who are bilingual Spanish-English or who use Spanish only may perform very differently even from each other (K. Wilcox & McGuinn-Aasby, 1988). These differences may reflect U.S. regional differences, country of origin, or dialectal or socioeconomic differences (M. Norris, Juarez, & Perkins, 1989). In general, second-language learning is more difficult than first-language learning, which for most children is fairly effortless. A language assessment must distinguish between those errors that reflect this difficulty and those that represent a language impairment. Most children are sequential bilingual learners: The first language (L1) has reached a certain level of maturity before acquisition of the second language (L2) begins. Sequential learning may maximize the interference between the two languages. Interference is the influence of one language on the learning of another. For example, the English /p/ is difficult for Arabic speakers but not for Spanish speakers because of L1. Interference in simultaneous bilingual acquisition seems to be minimal (Genesee, 1988). Children who learn L1 at home and are not exposed to L2 (English) until school move toward L2 dominance in middle school, but the transition occurs earlier in comprehension than in production, suggesting interference in production (Kohnert & Bates, 2002). The monolingual model of development is inappropriate when describing second-language learning (Roseberry & Connell, 1991). Likewise, rate of learning is a poor index because of the many variables that affect second-language learning. Preschool children will have an immature L1 when introduced to L2. The result may be “semilingualism,” in which a child fails to reach proficiency in either language. A child may be delayed in development of L1 after exposure to L2 if the second language, is dominant in the culture. This situation is rarely considered in language assessments (Langdon, 1989). In general, competence in L2 is related to the maturity of L1. The more mature a child’s use of L1, the easier it is to learn L2 (Jacobson, 1985). Initially, a child in preschool may be silent for a while on exposure to L2 and appear to have a language impairment. It takes time for a child to decipher the linguistic code (Schiff-Myers, Coury, & Perez, 1989). Older children possess metalinguistic skills that aid in this deciphering process. School-age children exposed to L2 may appear to have LD. The decontextualized language of the classroom may be especially difficult. If exposure to L2 does not occur until after age 6, it may take five to seven years to acquire age-appropriate cognitive and academic skills. The result is that in the United States many children have never fully developed L1—often Spanish—and are deficient in academic use of English (L2). L1 may exhibit arrested development or be lost if it is not used, is not valued by the child, is discouraged by the parents, or is considered less prestigious. Factors that affect L2 competency are individual characteristics, such as intelligence; learning style; positive attitude about one’s self, one’s own native language, and the target language; extrovertism and a feeling of control; a lack of anxiety about L2 learning; and home and community characteristics, such as parental and community attitudes and the level of literacy in the home. Low socioeconomic status alone is not a negative factor but may be paired with poor literacy or poor L1 use in the home and/or little opportunity to converse one-on-one with mature L2 users (K. Nelson, 1985). When compared to adults learning L2, children show a greater readiness to learn, are more perceptive of sounds, are less subject to interference from L1, and learn through sensory activity within


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the immediate context (Hamayan & Damico, 1991). Adult learning is verbal and abstract, emphasizing rule learning; children form their own abstractions of the rules from context. Children tend to acquire “chunks” of language, usually high-usage phrases, with conscious rule learning becoming more important after age 9 (Hamayan & Damico, 1991). Although children usually do not learn L2 faster or more easily than adults, they eventually outperform them (Genesee, 1987). Children are more likely to take language learning and use risks. In general, L1 forms a foundation for the learning of L2. What a child knows from one language is transferred to the other. This may be general knowledge about sentence construction and parts of speech or similar language processes if the languages are similar. Of course, interference also can occur, but its effects are usually minimal (Madrid & Garcia, 1985; Wolfram, 1985). A poor base in L1 usually leads to difficulties in L2. Languages other than English are devalued in the United States. This is the result of racial and ethnic discrimination and has resulted in a bilingual educational policy that sends a very clear message on the relative value of English (Schiff-Myers, 1992). The result is weakened linguistic and ethnic ties. The most common educational paradigm is a transitional bilingual program in which a child receives two or three years of bilingual education prior to placement in a monolingual English classroom. The not-so-subtle message is that English is better. Long-term maintenance programs that attempt to continue use and development of L1 are rare (Schiff-Myers, 1992). A period of even three years is insufficient for the child to attain academic proficiency in English. It is important that an SLP recognize the process of sequential bilingual acquisition. This is a dynamic process; a child’s language is changing. Performance may vary widely within and across children. Therefore, language assessments need to be tailored individually to each child (Hamayan & Damico, 1991; Hyltenstam, 1985). LACK OF APPROPR IATE ASSESSM E NT TOOLS We can expect the performance of CLD children on formal tests to be affected by cultural differences. Negative listener or tester attitudes also affect children, causing poor performance. The result is lower expectations and inappropriate referral or classification (Cummins, 1986). Few nonbiased standardized language tests are available for evaluating children with CLD backgrounds (Bernstein, 1989). Tests are typically unique to one culture or language. Spanish versions of most tests fail to consider dialectal differences and are normed on monolingual children (GutiérrezClellen & Simon-Cereijido, 2007). In two judicial decisions regarding placement of Mexican American and African American children in classes for the retarded (Diana v. State Board of Education, 1991; Larry P. v. Riles, 1984), the courts ruled that judgments made on the basis of responses to tests whose norming populations are inappropriate for these children are discriminatory. Many of the tests widely used in speech-language pathology are normed on population samples with a disproportionately high number of middle-class, European American, English-only children. Tests may yield lower scores for lower socioeconomic groups and for African American children. Some test items may be culturally biased against certain children. A critical need exists for nonbiased language testing for children of color, especially those from lower socioeconomic backgrounds (Rhyner, Kelly, Brantley, & Krueger, 1999). Having said all this, when we survey SLPs, we find that most use formal, standardized English tests to assess bilingual children (Caesar & Kohler, 2007). In general, poor performance leads to lower expectations (Adler, 1990). It is inappropriate to compare children with LEP to native speakers of English. The use of chronological norms is especially

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Assessment of Preschool and School-Age Children with Language Difference


questionable, given the great variety in developmental rate among CLD populations (Seymour, 1992). The child with LEP does not have language similar to a native speaker of English of a certain age. The problem becomes deciding what standard to use (Lahey, 1992).

Overcoming Bias in an Assessment The goal of a communication assessment with children with LEP is to differentiate difficulties that result from experiential and cultural factors from those that are related to language impairment (Damico, 1991b). Both groups may have some language difficulties. Adolescents in need of intervention also exhibit greater difficulty expressing themselves, establishing greetings and opening and maintaining a conversation, listening to a speaker, and cueing a listener to a topic change (Brice & Montgomery, 1996). Both cultural and linguistic factors influence performance in an assessment (Chamberlain & Medinos-Landurand, 1991). These may lead to misinterpretations and miscommunication. An SLP must be careful not to stereotype behavior and draw incorrect and unfair conclusions. For example, Latino American children may seem uncooperative and inattentive, when, in fact, their behavior signifies different concepts of time, body language, and achievement. An SLP can avoid biasing data interpretation by asking the following questions (Damico, 1991b): 1. Are there other variables, such as limited exposure to English, infrequency of error, testing procedural mistakes, extreme test anxiety, or contextual factors, that might explain the difficulties exhibited with English? 2. Are similar problems exhibited in L1? 3. Are the problems exhibited related to second-language acquisition or dialectal differences? 4. Can the problems exhibited be explained by cross-cultural interference or related cultural phenomena? 5. Can the problems exhibited be explained by any bias effect related to personnel, materials, or procedures that occurred before, during, or after assessment? 6. Is there any systematicity or consistency to the linguistic problems exhibited that might suggest an underlying rule? An SLP should interpret the child’s performance in light of the intrinsic and extrinsic biases inherent in the assessment process. Intrinsic biases, such as knowledge needed and normative samples, are part of the test, while extrinsic biases, such as sociocultural values and attitude toward testing, reside in the child. When groups of minority children score similarly to the norming population—as on the Communication and Symbolic Behavior Scales (Wetherby & Prizant, 1993)—it suggests a less biased assessment device (Roberts, Medley, Swartzfager, & Neebe, 1997). Similarly, the Expressive Vocabulary Test (Williams, 1997) is a screening measure that has been reported to be culturally fair and appropriate for use with African American children (Thomas-Tate, Washington, Craig, & Packard, 2006). On the other hand, scores of low-income African American children on the Preschool Language Scale–3 (Zimmerman, Steiner & Pond, 1992) suggest that, even though the test is generally nonbiased, some items should be interpreted with caution because they are problematic for these children (Qi, Kaiser, Milan, Yzquierdo, & Hancock, 2003). Language use patterns of both a child and an SLP and the language-learning history of that child also may influence the assessment. Communication and interactive style are culture bound.


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Bias can be overcome by addressing cultural and linguistic influences in a four-step process (Chamberlain & Medinos-Landurand, 1991): 1. Recognize and identify variables that might affect the assessment. 2. Analyze tests and procedures for content and style. For example, the Fluharty Speech and Language Screening Test accepts an /f/ for /θ/ substitution on teeth as dialectal, but in New Orleans, African Americans substitute /t/ to produce teet (/tit/) (Campbell & Champion, 1996). In addition, simply asking children to repeat what the SLP says may go against the cultural norm. Some African American children are not expected to imitate adults. 3. Take variables into account and change procedures. 4. Teach test-taking strategies. An SLP should be mindful that each child’s level of acculturation will differ with the age of the child and the extent of exposure to both cultures. USE OF I NTE R PR ETE R S The accuracy of testing with children with LEP may be increased by using interpreters who speak the child’s primary language (Watson, Omark, Gronell, & Heller, 1986). When an interpreter is not available, family members can aid the SLP. Children with CLD backgrounds perform significantly better with familiar examiners (Fuchs & Fuchs, 1989). This finding suggests the use of interpreters familiar with both the language and the culture of a child and his or her caregivers. In addition, it suggests that consistency is important. An SLP must recognize the limitations of the process and must select and train the interpreter carefully. They must work together as a team with mutual respect. Three factors seem critical in the use of interpreters: selection, training, and relationship to the family and community (N. Anderson, 1992; Chamberlain & Medinos-Landurand, 1991; Randall-David, 1989). Let’s say a little more about each one. Selection Selection should be based on a potential interpreter’s linguistic competencies, ethical and professional competencies, and general knowledge and personality (Chamberlain & Medinos-Landurand, 1991). An interpreter should possess a high degree of proficiency in both L1 and English, be able to paraphrase well, be flexible, and have a working knowledge of developmental, educational, and communication terminology. Ethical and professional competencies should include an ability to maintain confidentiality, a respect for the feelings and beliefs of others and for the roles of professionals, and an ability to maintain impartiality. Confidentiality is especially important if the interpreter is a resident of the immediate geographic area served. Finally, it is very desirable for the potential interpreter to have a knowledge of child development and educational procedures. Personal attributes include flexibility, trustworthiness, patience, an eye for detail, and a good memory. Training Training must include the critical factors of assessment and intervention, including procedures and instruments (N. Anderson, 1992). The interpreter must understand the importance of exact translation from L1 to L2 and the reverse.

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Preassessment training must include the elements of a thorough assessment and the methods of specific test protocols, including technical language. Rapport-building strategies and questioning techniques also should be taught. Prior to each evaluation of a child’s language, the SLP and the interpreter should review each case and the assessment procedures; practice pronunciation of the name, introductions, questioning, and nonlinguistic aspects of the interaction; and discuss the topics to be introduced. During the evaluation, the interpreter can interact with the child and caregiver(s) while the SLP records the data and directs the process. In the postassessment interview with caregivers, the interpreter will convey the results of the evaluation as they are reported by the SLP. Relationship with Family and Community Prior to the assessment, the interpreter should try to get to know the caregiver(s) and child. It is very important that the interpreter convey the confidentiality of the proceedings, especially if the interpreter is from the community. During the assessment, the interpreter is to translate exactly. The SLP can aid this process by keeping interactional language simple and use of professional jargon to a minimum. It is the interpreter’s responsibility to ensure that the caregivers thoroughly understand the process and the results and recommendations. Conclusion Working through interpreters is difficult and does not address some of the other problems in assessment with children with LEP. The following list contains suggestions for working successfully with an interpreter (Lynch & Hanson, 1992; Randall-David, 1989). The SLP should 1. Meet regularly and keep communication open and the goals understood. 2. Have the interpreter meet with the child and caregiver(s) prior to an interview to establish rapport and to determine their educational level, attitudes, and feelings. 3. Learn proper protocols and forms of address in the native language. 4. Introduce himself or herself to the family, describe roles, and explain the purpose and process of the assessment. 5. Speak more slowly and in short units, but not more loudly. 6. Avoid colloquialisms, abstractions, idiomatic expressions, metaphors, slang, and professional jargon. 7. Look directly at the child and caregiver(s), not at the interpreter. Address remarks to the caregiver(s). 8. Listen to the child and caregivers to glean nonlinguistic and paralinguistic information. What is not said may be as important as what is said. 9. Avoid body language or gestures that may be misunderstood. 10. Use a positive tone that conveys respect and interest. 11. Avoid oversimplification and condescension. 12. Give simple clear instructions and periodically check the family’s and child’s understanding. 13. Instruct the interpreter to translate the client’s words without paraphrasing. 14. Instruct the interpreter to avoid inserting her or his own word or ideas in the translation or omitting information. 15. Be patient with the longer process inherent in translation.


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Although these suggestions will not ensure success, they may lessen some friction that potentially could disrupt effective delivery of services. ALTE R NATIVE ASSESSM E NT The following five guidelines should be considered prior to using standardized tests with children from CLD backgrounds (Musselwhite, 1983): 1. What is the relationship of the norming population and the client? Are enough minority children included to give a fair representation? Are separate norms used for different minority groups? 2. What is the relationship of the child’s experience and the content areas of the test? Items using farm content, for example, may have little relevance for children in the inner city. 3. What is the relationship of the language and/or dialect being tested and the child’s language and/or dialect dominance? This issue is critical in determining language impairment. The determining factor should be the child’s ability to function within her or his own linguistic or dialectal community (Iglesias, 1986). 4. Will the language of the test penalize a nonstandard child by use of idiomatic or metaphoric language? 5. Is the child penalized for a particular pattern of learning or style of problem solving? Test scores should not be taken at face value. For example, the omission of some morphological endings by bilingual children is similar to the error pattern of children with SLI, leading to possible misdiagnosis (Paradis, 2005). Although differences do exist, they are often subtle and require great care when examining assessment results. When bilingual Spanish-English children who are typically developing (TD) and those with LI are compared on use of English past tense, different error patterns emerge (Jacobson & Schwartz, 2005). In addition to scoring lower with regular past-tense -ed on real and nonsense verbs and with irregular past tense verbs, bilingual children with LI made significantly more omission errors, while TD children made overgeneralization errors (eated, sitted). All is not lost. American English standardized tests can be used with modified procedures to enhance performance. Modifications may aid an SLP in describing a child’s language and communication skills. Obviously, the scores from such testing would be invalid, although the descriptive information may be invaluable. If reported, the scores must be qualified by a description of the modified procedures. Dual sets of norms—those from the test and locally prepared ones—can be used to compare the performance of children from CLD backgrounds to that of the standard group and of their peer group (Musselwhite, 1983), but they must be used cautiously because most likely the test will still be in Standard American English (Seymour, 1992). It seems more appropriate to measure a child’s performance in his or her dialect and compare this performance to that of other children also using that dialect (Seymour, 1992). Unfortunately, we have very little data on this development and even fewer tests. Parents, who presumably speak the same dialect, may be used as referents when very little normative data are available (Terrell, Arensberg, & Rosa, 1992). A language test can be given to both the parent and the child. Once enough data has been gathered, the SLP can compare the child’s performance with that of the adult. Assuming the adult has no language impairment, child use that reflects parent use but that differs from Standard American English would represent a dialectal difference, not a disorder. For example, omission of final plosives found in African American English would result in omis-

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Assessment of Preschool and School-Age Children with Language Difference


sion of the regular past tense marker -ed. Just testing the child, an SLP might assume that the child does not have past tense. Parental omission would confirm a dialectal difference. Some tests have been normed on population samples from different languages, such as children speaking English and Spanish, by using English and a Spanish translation. Results of translated tests must be used very cautiously because they assess structures important for speakers of English and ignore those of the other language. For example, hitting something with a stick in English is sticking in some Spanish dialects, but that verb is not used with other types of hitting. The standardized norms from such translated tests could be used to identify children with language differences. Children who exhibit LI relative to their peer group could be identified by use of the peer group norms. Even this procedure may bias some results, given the diversity of some populations, such as Latinos. Norms for all speakers of a language fail to consider dialectal variations. Other variables, such as socioeconomic status, family grouping, length of time exposed to English, and quality of L1 used at home, affect the child’s performance. Locally prepared norms may be more appropriate. The differences found between majority and minority children on knowledge-based tests are not found on process-based evaluations (Campbell, Dollaghan, Needleman, & Janosky, 1997). It may be possible to reduce bias in language testing of children with CLD backgrounds by using methods and tools that emphasize processing abilities, such as memory and perception, rather language experience and knowledge (Campbell, et al., 1997). Process-based tests can be useful in distinguishing LI from experiential difference. Processes are the mental operations required to manipulate linguistic material. Testing might include such tasks as nonword vocal repetition, completion of two language tasks simultaneously, and following directions. To ensure that past learning is minimized, tasks should be completely novel, and task-related vocabulary and grammar should be familiar or, if not, reviewed prior to testing.

An Integrated Model for Assessment Current methodology in language assessment has been described as a “discrete point approach” (Acevedo, 1986; Mattes & Omark, 1984) in which language is treated as an autonomous cognitive ability divided into many components (Damico, 1991b). Language is not viewed as holistic; rather, it is separate from environmental variables and context. We addressed this issue in the previous chapter. It is not surprising that several SLPs have suggested an integrated approach for CLD children, one that uses the child’s natural environment and that depends on descriptive analysis, rather than on normative test scores. Language and communication are not static, divisible, and autonomous, but dynamic, synergistic, and integrative (Damico, 1991b). Such an assessment would focus on the functional aspects of language and on flexibility of use. The overall question would be: “Is this child an effective communicator in his or her context?” The criterion is not norm referenced, but “communication referenced” (Bloom & Lahey, 1978), with an SLP determining the indices of proficiency. Data could be collected in natural settings (Iglesias, 1986) as a child converses with his or her natural conversational partners, parents, teachers, and peers. Assessment would begin with data gathering. This collection process might include screening all children for other-than-English and for nonstandard dialectal use. This step could be followed by referral information from classroom teachers on children experiencing academic difficulty (Chamberlain & Medinos-Landurand, 1991). Early intervention may prevent difficulties or inappropriate classification later (Garcia & Ortiz, 1988). A teacher checklist of the child’s language functions, a questionnaire,


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and/or caregiver interview might follow. Parents can also be a source of information. Not surprisingly, Spanish-speaking parents are as accurate in reporting the expressive vocabulary and grammar of their toddlers as monolingual English-speaking parents (Thal, Jackson-Maldonado, & Acosta, 2000). Parental reports of bilingual children’s vocabulary and word combinations are consistent with sampling findings (Patterson, 2000). In addition to verifying demographic information, an SLP should observe the child in the classroom and with peers and caregivers. Of interest is the child’s language use, academic strengths and weaknesses, and learning style. Data collection and observation would be followed by testing and language sampling. Sampling should include a wide variety of settings and activities to increase the accuracy of the language sample collected (Bernstein, 1989). Parents can be trained to listen to their child, observe language use, and discuss linguistic interactions. CH I LDR E N WITH LE P The data collection stage is particularly important for children with LEP. Many variables affect secondlanguage development and are of interest. In addition, seemingly simple information such as age—Is the child age 1 at birth or a year later?—is culturally dependent and can greatly affect determinations of impairment. Considerations for children with LEP include the degree of exposure to English-speaking peers, self-esteem, personality (introverted vs. extraverted), motivation to learn English, family attitude toward English, ethnic community’s view of education, the socioeconomic status of the family and of Englishspeaking peers, and the process of learning a second language (Roseberry-McKibben, 1994). The same child may appear very different depending on the stage of second-language development. Four measures may be especially important in discriminating predominantly Spanish-speaking children with LI from those developing typically (Restrepo, 1998). These are parental reporting, a family history of speech and language problems, the number of errors per T-unit, and the mean length of T-units. A T-unit is a main clause and phrasal or clausal embedding attached to it. T-units will be discussed in more detail in Chapter 7. Language assessments should occur where a child and her or his caregivers are most comfortable, such as the home. Parents, especially recent immigrants, may speak little or no English. A properly trained interpreter can be very helpful in obtaining needed information. Occasionally, older siblings have sufficient English skills to answer questions or to translate for their parents. Table 4.2 contains possible questions to be asked in an interview. TABLE 4.2

Interview Questions for Children with LEP or Children with Different Dialects

Demographic How long has the family been in the United States? In which country were the parents born? From which country did the family immigrate? How much contact does the family have with their native country? * How long has the family been in this community? Is the family connected to a large community from their native country? Is there any plan to return to the native land to live?

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Assessment of Preschool and School-Age Children with Language Difference


Family * How old is the child? * Which family members live in the household? Number of siblings? * Are other individuals living in the household? In what cultural activities does the family participate? * Who is primarily responsible for the child? (Primary caregiver?) * Who else participates in caregiving? * Approximately how much time do the child and caregiver spend together on a typical day? * With whom does the child play at home? * How much education do family members have? In what language? Childrearing * Are there scheduled meals? * What types of foods usually are eaten? * Is there an established bedtime? * Does the child misbehave? How? How is the child disciplined? Who disciplines? Are any television shows (radio shows, videos) in the native language? If so, how often does the child watch such shows? * Are stories read or told to the child? If so, in what language? How often? * Are there books, magazines, or newspapers in the home? In what language? * At what age did the child begin school? * Has the child attended school regularly? * How many schools has the child attended? What language has been used in the classroom? Attitudes and Perceptions * Is blame assigned for the child’s problems or condition? To whom or what? * How does the family view intervention? Is there a feeling of helplessness? How does the family view Western medical practices and practitioners? Who is the primary provider of medical assistance and information? * From whom does the family seek assistance (organizations and individuals)? * What are the general feelings of the family when seeking assistance? * Does one family member act as the family spokesperson when seeking assistance? * How is the child expected to act toward parents, teachers, or other adults? Adults toward the child? Are there any restrictions or prohibitions, such as the child not making eye contact or not asking questions? * How important are English language skills? Language and Communication What language is spoken in the home? Between adults? Between caregivers and the child? Between the children? When playing with neighborhood friends? Other caregivers and the child? How much English is used in the home? What language is used in community activities, such as church, Girl Scouts, and team sports? At what age did the child begin to learn English? Where and how? * At what age did the child say the first word? Use two-word utterances? *Applicable to both LEP and dialectally different children. Source: Compiled from N. Anderson (1991); Chamberlain & Medinos-Landurand (1991); Mattes & Omark (1984); SchiffMyers (1992); Wayman, Lynch, & Hanson (1990).


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Observation should occur in several settings with different conversational partners, topics, and activities. This tactic will give an SLP some idea of the extent of bilingualism and possible language and communication difficulties. Because the manner of a child’s development of two languages and the child’s environment interact, it is important to assess in both languages. Each child’s language skills must be compared to sociolinguistic factors such as the following: at exposure to each language • Age Extent to each language • Ability ofto exposure use each language • Comparative linguistic structure of the two languages • Individual child differences (Goldstein, 2006) • Assessment in both languages is especially important for preschool and kindergarten children in order to evaluate development in both (Hammer, Lawrence, & Miccio, 2007). The languages used in testing and the manner of their presentation differ with each child and the purpose of the evaluation. It is important to establish the primary language, language dominance, and language proficiency in both languages. Testing in both L1 and English seems essential for assessment of language impairment. In fact, federal law requires bilingual testing before such determinations are made. Successive testing in the stronger language, followed by the weaker, results in the best performance, especially for young children with monolingual L1 homes (Krashen & Biber, 1988), although simultaneous testing may be best for children who exhibit poor competence in both languages or who speak a combined L1 – L2 language, such as “Spanglish” (Cummins, 1986). The mode of administration and scoring can greatly change the reported responses of bilingual children on vocabulary assessment. The number of correct responses increases as SLPs move from monolingual to bilingual administration and from monolingual scoring to conceptual scoring in which the child is credited for different aspects of meaning (Bedore, Peña, Garcia, & Cortez 2005). If, for example, a Spanish-English-speaking child is shown a picture of housecat, she might respond with “cat” or “gato” or with both words. That is one aspect of the definition, the entity’s name. If the child adds, “It’s like leon in jungle,” she has added a new aspect to the definition and demonstrated conceptual knowledge. This example is very simplistic. Conceptual knowledge can be assessed using questions such as the following in response to objects and pictures. Tell me three things about . . . Describe what an X looks like. This is Rosa. Tell me what she looks like. What shape is X? What do you do with X? What is the difference between X and Y? What are they going to do? Normative testing should be supplemented by probing. As mentioned, children with CLD backgrounds score lower on knowledge-based testing, such as that found in normative procedures, but the same on process-based assessments, such as comprehension and production of real conversations (Campbell et al., 1997). Dynamic assessment tasks are more appropriate and deemphasize grammar in favor of

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Assessment of Preschool and School-Age Children with Language Difference


ability to communicate and learn (Butler, 1993; Damico, 1991b). Tasks are interactive, focused on learning, and yield information on learner responsiveness (Gillam, Peña, & Miller, 1999). Dynamic assessment is based on the educational notion of zone of proximal development (Vygotsky, 1978), or the difference between a child’s current performance on a task and the amount of guided assistance needed by the child to be successful. Thus, in dynamic assessment an SLP is interested not only in a child’s performance but also in the best way to facilitate learning and in the child’s ability to respond to learning. The three primary methods are “testing the limits,” graduated prompting, and testteach-retest (Gutierrez-Clellan, & Peña, 2001). In testing the limits (Carlson & Wiedl, 1992), an SLP probes behind a child’s response using elaborative feedback and verbal explanations by a child to determine his or her understanding of the task and the way in which he or she arrived at the response. For example, a child may have interpreted the word buoyancy as boy-in-seat (Peña, 2002). Graduated prompting is a method of probing a child’s readiness for learning. By subtly manipulating the prompts given to a child, the SLP determines the level of support needed by a child in order to be successful. In essence, the SLP is trying to bridge the gap between what a child knows and the requirements of the task. In a test-teach-retest format, an SLP becomes an active agent of change. Focusing on “how” rather than “what” children learn, language-neutral dynamic tasks can provide a nonbiased assessment (Lidz & Peña, 1996). The initial test establishes a baseline measure, then during teaching the SLP supports learning and discovers how modifiable a child is and how a child responds to adult support. The method of teaching called mediated learning experience (MLE) is an individualized approach to the response and strategies used by a child and includes explaining the importance of the learning and giving evaluative feedback (Peña, 2002). Several types of mediation are possible (Lidz, 1991), including mediation of the following: Informing a child of the purpose for the interaction and attempting to maintain • Intentionality: a child’s involvement Focusing a child’s attention on important features and helping a child understand their • Meaning: importance and relevance Bridging concepts and learning beyond the immediate context by relating • Transcendence: specifics of the task to other experiences Encouraging a strategic, deliberate approach to problem solving and manipulat• Competence: ing a task to help a child be successful The focus is not simply on what a child learns but also on how a child learns. An example of MLE is presented in Table 4.3. In retesting, or posttesting, children with LI usually demonstrate little change (Pena, Iglesias, & Lidz, 2001). The SLP is also interested in the way in which a child thinks that results in the answers the child gives. This requires probing of a child’s responses. One method of testing or probing that circumvents an SLP’s inability to speak the native language and the affects of delayed English acquisition is the invented rule (Connell, 1987c; Roseberry & Connell, 1991). For example, an invented rule might state that /i/ is added to a noun to mean a portion of that noun, as in book and book-/i/. This procedure can be taught through modeling and can be tested with novel objects. Modeling would be a two-step process: “This is X, X,” as the speech-language pathologist points. “This is X-/i/, X-/i/,” as the speech-language pathologist points.


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Examples of Mediated Language Experiences (MLE)

Introduction Today we’re going to play with some special toys and use them in special ways. While we’re using the toys we’ll think about the actions we do with each and the different names we use. Now, what are we going to be talking about? [Child response] Um-hm, and why do you think it would be important to be able to name the different actions that we can do? [Child response] Good, so we can explain our actions to other people. Can you think of anything else? [No response] Do you ever ask for some help from your mother? [Child response] And . . . [Child response] Yes, of course, we can use actions to ask others to help us. Suppose I called your mother and said, “Dad!” [Child response] You’re right, it would be the wrong name. To help people understand us, we call things by their right name. I know that you have a dog. What’s his name? [Child response] Okay, if I called him something else, would he answer? [Child response] No. So names are important. We call actions by their right name too. I have a whole box full of different objects. Some tell us what we do with them. Here’s one your mother uses. It’s called an iron. And what do we do with it? [Child response] Right, we iron, we iron clothes. That was a hard one. How should we name the actions that go with each object? [No response] Would it help to name the object? [Child response] Okay, let’s begin that way. Suppose that you know the name of the object but not the name of the action? [Child response] Well, I could tell you but can you think of a way to show me what you know? [Child response] Good, you could show me by doing the action. Then together we can figure out the name of the action, maybe from the object used or their might be other ways to remember. . . . [Lesson continues]

Within lesson Now we’ve named all the actions. Some objects have more than one. Let’s try something else. You name the action and I’ll name the object. Only one rule, you cannot repeat an action. If you can’t think of the action, act it out and I’ll try to help. . . . [Continues] Do you know how to play Simon Says? [No response] Well, in this game you get to be the queen and you tell me what to do. Let’s use your name: “Catalina says, ‘Eat!”’ [SLP pretends to eat in a very sloppy manner. Child laughs.] Now you try one. . . . [Continues] Wow, that was fun. What a busy queen you are! Look at this. I have a book full of actions. Let’s see if we can describe what’s happening in the book. . . . [Continues]

Conclusion You worked really hard today. Do you remember what we learned? [Child response] Why are action names important? [Child response] And what did you do when you couldn’t think of the action word? [Child response]

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This would be repeated several times with a few items as the child repeats the SLP’s production of the noun and the noun plus /i/. Testing would follow a cloze procedure: “This is Y, Y. This is _____.” Again the SLP would point to pictures illustrating the meaning. Of interest is whether a child can abstract a language rule and then apply it to novel situations, certainly an important skill for language learning. Naturally, the same picture of objects would not be used for both testing and training to enable the SLP to assess learning and generalization. Possible pictures to be used for testing or training are presented in Figure 4.1. For example, the SLP says, “This is clock; this is _____ (clocky).”

11 12 1

11 12 1

10 9




3 7



10 9

2 3


4 7



FIGURE 4.1 Possible format for invented rule assessment.


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Structured tasks designed by an insightful SLP can also provide more flexibility than standardized tests and may be effective assessment vehicles (R. T. Anderson, 1996). Table 4.4 is an example of a structured format that has been used effectively with Spanish-speaking 4-year-olds. Throughout this text, I stress the need for alternatives to standardized testing, such as language sampling. For children from CLD backgrounds, language sampling and ethnographic interviewing are essential parts of any language evaluation (Battle, 2002). Although useful, language samples are not guaranteed to be nonbiased. All interactions are culturally based and have the potential of biasing results against a child. Members of the community or family should aid the SLP in analyzing a child’s language sample. Sampling should reflect an “authentic assessment” (Udvari & Thousand, 1995) based on the realistic demands of a child’s communication contexts, such as the classroom. In this setting, a sample should reflect the contextual, performance, and instructional constraints of the situation (Rosin & Gill, 1997). A child can then be measured against the minimal competency needed to function within that context (Stockman, 1996). Authentic assessment is a clear example of the functional assessment methods described in this text. Of course, children’s responses will differ with the task used to elicit language. For example, based on the type of narrative eliciting task, bilingual Spanish-English 4- to 7-year-old children’s narratives will differ in both the amount of each language produced and the amount of language mixing (Fiestas & Peña, 2004). CH I LDR E N WITH DI FFE R E NT DIALECTS Naturally, an SLP will want to gather similar data about a child with a minority dialect. Possible interview questions are contained in Table 4.2. Observation and testing are similarly important. TABLE 4.4

Script for Structures Task

A. Negatives Materials


1. broken doll 2. car with wheels missing 3. small box/large object 4. empty box 5. box that will not open

1. Ask child to show body part that is missing. (¿Dónde está _____?) 2. ¿Qué le pasa al carro? 3. Pon (object) en la caja. 4. Busca _____ en la caja. 5. Abre la caja, por favor.

B. Verbs: third-person singular and plural—past and present progressive Materials: family, house, and furniture Perform the following actions with one family member (singular) and with more than one family member (plural). 1. 2. 3. 4. 5.

dormir comer cocinar saltar/brincar bailar(se)/lavar(se)

Chapter 4

Assessment of Preschool and School-Age Children with Language Difference


Verbal prompts: Ahora vamos a (action). 1. past tense—Yo (action—past tense). ¿ Qué hizo/hicieron? 2. present progressive—A mí me gusta (action) y a éi/ella/ellos también. ¿ Qué está pasando? C. Verbs: third-person present indicative Materials: doll house and dolls Prompts: While playing with the dolls, talk about different things that people do, such as “Las mamás cocinan; los niños corren.” Then ask: 1. 2. 3. 4. 5.

¿ Qué hacen las mamás? ¿ Qué hacen los niños? ¿ Qué hacen las maestras? ¿ Qué hacen los pájaros? ¿ Qué hacen los perros?

D. Copula “ser” Prompt: Provide incorrect information when identifying objects. Use the furniture and the dolls for prompting. For example, say that the mother doll is the father doll and insist on it. Repeat this with the following: 1. 2. 3. 4. 5.

mother/father table/chair bathroom/kitchen car/airplane cat/dog

E. Locatives (sobre/en/encima, debajo/abajo, detrás/atrás) Prompt: Play hide and seek with a variety of objects (doll house) and ask the child where the objects are. F.

Plural, third-person subject pronouns and possessive constructions Prompt: Game of Who has _____? Whose is _____? and What does _____ have? Plural: Prompt: Qué tienes/tengo? /s/ morpheme carro plato taza/vaso mesa silla Third-person pronoun:

/es/ morpheme botón lápiz papel avión tenedor

Prompt: Male and female dolls will participate as third-person referents in game: ¿Quién tiene (object)? Possessive construction: Prompt: Using male and female dolls, ask: ¿De quién es (object)? Source: Reprinted with permission from Assessing the grammar of Spanish-speaking children: A comparison of two procedures by R. T. Anderson. Language, Speech, and Hearing Services in Schools, 27, 333–344. Copyright © 1996 by American Speech-Language-Hearing Association. All rights reserved.


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Communication Assessment

Family and community members can aid an SLP in assessing performance, especially in the language sample (Bleile & Wallach, 1992; T. Campbell & Dollaghan, 1992). In one study, African American Head Start teachers were asked to judge children with poor speech and those with typically developing speech (Bleile & Wallach, 1992). The poor-speech samples were analyzed, and a set of community standards derived. Similar but more stringent social validation has been accomplished by using direct magnitude estimates (DME) of subjective judgments. In DME, stimuli are scaled by assigning numerical values to them on the basis of their relative magnitude along some continuum. Each child’s language speech sample is rated against a standard, the language of a child with no language impairment. If raters listen to several children and score them against a taped standard, they can begin to form a continuum of performance. For stability of scoring, at least ten listeners are required. Performance of a single child can be compared over time to measure improvements and can be compared with others by using the same dialect to assess overall performance. Obviously, child-centered sampling has the potential of reducing the impact of biases found in testing. Performance will vary across different language tasks. For example, 4- to 6-year-old speakers of African American English (AAE) use more AAE forms on picture description tasks than in free play (Washington, Craig, & Kushmaul, 1998). Because even heavily dialectal speakers use dialectal forms on only about 20 percent of words, sample analysis should focus on nondialectal components (Craig & Washington, 2002). The shared features of AAE and Standard American English may be more diagnostically important in assessing language impairment among African American children speaking AAE (Seymour, Bland-Stewart, & Green, 1998). SU M MARY Despite the incredible difficulties inherent in assessing children with CLD backgrounds, there is hope. The same integrated, functional methodology proposed for native speakers of English can be used with some modifications with these children as well. With sensitivity, unbiased administration of testing, and sampling within the everyday context of a child, a fair and meaningful assessment can be accomplished.

Conclusion Unfortunately, sometimes a battery of readily available tests is given to every child regardless of possible language impairment. This passes for an individualistic and thorough assessment. As with intervention, assessment procedures must be designed for the individual client. Standardized tests are only a portion of this process. Language tests are only aids to an SLP and cannot substitute for the informed clinician. A thorough assessment includes a variety of flexible procedures designed to heighten awareness of the problem and enables an SLP to delineate more clearly the language abilities and impairments of the child with a CLD background. For training to be truly functional, a thorough description of a child and that child’s language must be made.



Language Sampling


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Communication Assessment


lthough tests are good for assessing global change, they miss many small or subtle behaviors. Language sampling provides more specific information for planning intervention because it includes both the content and context of language use. If the goal of language intervention is generalization to the language used by a child in everyday situations, it is essential that an SLP collect a language sample that is a good reflection of that language in actual use. And that’s what we’re going to learn to do. It is important that some portion of the sampling be accomplished in real communication situations (Olswang, Coggins, & Timler, 2001). In general, the processing demands of contrived situations are fewer than in real-life interactions. With the increased demands and multiple cues of natural situations, the language performance of many children with LI will deteriorate. As demands increase, the cognitive and linguistic resources available to process them change. Within real communication, the variables include the structure of the interaction, the number of individuals involved, distractions, and the immediacy and complexity of the language being received and produced. If we are going to program for use within a child’s natural communication contexts, then we must assess within those same contexts. So all these variables are present. Good language samples do not just occur. They are the result of careful planning and execution. An SLP can design the assessment session so that the context fits the purpose of collecting the desired sample. The result is usually a combination of free conversation sampling and some evocative techniques. Both are essential. For example, children with autism perform poorly on both standardized tests and spontaneous language samples (Condouris, Meyer, & Tager-Flusberg, 2003). With these children, evocative techniques may be crucial. An SLP must make several decisions before collecting the sample. After studying the interview, observational, and testing results, decisions must be made relative to the context, participants, materials, and conversational techniques to be used. It should be remembered that “there is no way to ‘make’ children talk . . .[the SLP] can only make them want to talk by creating a situation in which there is a reason to talk and an atmosphere that conveys the message that . . .[the SLP is] interested in what they have to say” (Lund & Duchan, 1993, p. 23). In this chapter, we cover the planning, collection, recording, and transcription of conversational samples.

Planning and Collecting a Representative Sample Several issues are of importance when planning and collecting our language sample. Among the most prominent are the representativeness of the sample and the effect of conversational context. In addition, collection of several language forms and functions may require the use of evocative techniques. All of these issues are important for children with language impairments and also for children with CLD backgrounds. R E PR ESE NTATIVE N ESS Representativeness or typicalness can be addressed by ensuring spontaneity and by collecting samples under a variety of conditions. Spontaneity can be achieved if a child and a conversational partner engage in real conversations on topics of interest to the child. To ensure spontaneity, an SLP can follow the (LCC)3 formula for (a) less clinician control, (b) less clinician contrivance, and (c) a less conscious child (Cochrane, 1983).

Chapter 5

Language Sampling


An SLP’s control of the context should be weak so as not to restrict a child’s linguistic output in quantity or quality. Although there is some indication that SLP style has little effect on gross measures, such as average or mean utterance length, more subtle measures may be affected to a greater degree. Control devices, such as the use of questions and selection of topics by the SLP, may cause a child to adopt a passive conversational role and contribute little. When a child will participate freely and willingly, other, more structured approaches may be required. For example, an SLP can elicit longer and more complex language from young children with picture interpretation tasks than with imperatives or story recitation. In storytelling, the use of pictures can enhance the length and complexity of the sample, especially if an SLP gives cues, such as “Tell me a story about this picture. Begin with ‘Once upon a time.’ ” The least spontaneous condition involves the specific linguistic tasks of answering questions or completing sentences. The effects of each technique will vary with each child. An SLP can relinquish some control by placing these tasks within a less formal or play format. The sample will be less contrived if the SLP follows the child’s lead and adopts the child’s topics for conversation. More contrived situations, such as “Tell me about this picture” or “Explain the rules of Monopoly,” do not elicit spontaneous everyday speech. The most contrived situation occurs when an SLP relies on a tried-and-true, never-fail list of standard questions used with every child. Finally, if a child is less conscious of the process of producing language, the sample will be more spontaneous. Asking a child to produce sentences containing certain elements, for example, makes the linguistic process very conscious and may be very difficult, especially out of context. Although a child may not be able to produce a sentence with has been on demand, the same child may be able to relate the story of the three bears with “Someone has been sleeping in my bed.” The former task requires metalinguistic or abstract linguistic skills that may be beyond the child’s abilities. A child’s caregivers can offer suggestions to the SLP on contexts to help obtain a representative sample. It may be desirable for caregivers to serve as partners, especially with young children. After the sample has been collected, caregivers can review the data and comment on the typicality of their child’s behavior. A VAR I ETY OF LANG UAG E CONTEXTS The sampling environment can contribute to representativeness if there is a variety of contexts, including various settings, tasks, partners, and topics. Context is dynamic and complex, and the effects are very individualistic. One child may respond well to a certain toy and partner, while another child does not. Yet, the effects of context are not often considered in language assessment. Contextual variables include the task or purpose of the activity, the opportunities to use language, the extent of ritualization in the event, the amount of joint attending, and the responsivity of the partner (Coggins, 1991). The task itself, as previously noted, can affect both the number and length of the conversational interactions (Conti-Ramsden & Friel-Patti, 1987). For example, young children are more referential, attempting to focus the listener’s attention in free play, and are more information seeking in book activities (Jones & Adamson, 1987). Similarly, parents are influenced by context and engage in more conversation when playing with dolls than they do with cars and trucks (O’Brien & Nagel, 1987). The opportunities to use language will vary and may need to be provided. Although specific elicitation tasks, described later, may work for older children, they may not be effective with toddlers (Coggins, Olswang, & Guthrie, 1987).


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Two aspects of context are structure and predictability (Bain, Olswang, & Johnson, 1992). Structure is the amount of adult manipulating of materials and evoking of particular utterances. Predictability is the familiarity of the overall task and materials. In general, children will produce a greater frequency and diversity of language features in low-structure situations and more new features in predictable ones (Bain et al., 1992). Free-play sampling contexts have both low structure and predictability. Possibly in such low-structure contexts, children assume that the adult knows very little about the situation. In restrictive, planned contexts, children may assume that the adult knows more, and thus children say less. Routinized events or routines provide mutually understood and conventionalized interactions. In routines, the partner provides order for the child, who, in turn, depends on the partner’s cuing. This informal, predictable structuring allows for a child’s maximum participation by providing scripts (Platt & Coggins, 1990). Scripts are linguistic and nonlinguistic patterns that accompany routines, such as “How are you?—Fine, thanks. How are you?” Scripts reduce the amount of cognitive energy required for a child to participate. In general, children produce fewer topics and fewer contingent or related utterances in “low-script” or unfamiliar contexts (Conti-Ramsden & Friel-Patti, 1987). An attentive, responsive partner will elicit more language from child. In joint, or shared, attention situations, children produce more extended conversation and are best able to determine the meanings and intentions of the partner (Snow, Perlman, & Nathan, 1987; Tomasello & Farrar, 1986). Similarly, timely responses by a partner increase a child’s understanding because there may be as little as a onesecond interval after a young child’s utterance when he or she can still perceive the relatedness of the partner’s following utterance. As stated, a child’s performance will vary with the amount of contextual support. This variability is important in considering intervention targets and methods (Coggins & Olswang, 1987; Olswang, Bain, & Johnson, 1990). Variety ensures that the sample will not be gathered in one atypical situation. Instead, variety can reflect a sampling of the many interactional situations in which a child functions. Although variety is desirable, it is not always practical, especially in the public school setting. Audio samples collected by the parent or teacher can provide an acceptable substitute. Settings and Tasks The best sampling context is a meaningful activity containing a variety of elicitation tasks. In general, a child who is more familiar with the situation will give the most representative sample. As mentioned, familiar routines provide a linguistic and/or nonlinguistic script that guides a child’s behavior. For young children, play with familiar toys and partners is one of these routine situations. Language is a natural part of many routine events. An SLP needs to decide whether a child’s typical or optimal production is desired. In general, young children engaged in free play produce more utterances than those telling stories; however, both story generation and conversation result in more complex syntactic structures than free play (Southwood & Russell, 2004). The differences in play and language behaviors of children with LI in various play situations with assorted partners emphasize the need to evaluate these children in multiple play and conversational situations with several different partners (DeKroon, Kyte, & Johnson, 2002). Although story generation elicits longer utterances than either free play or conversation, the context of story generation varies. While TD children in kindergarten and second grade provide more information when they are retelling a story than when telling the same story from pictures alone, the use of pictures in narrative elicitation tasks seems to increase average utterance length for adolescents with Down syndrome who need the extra input (Miles, Chapman, & Sindberg, 2006; Schneider & Vis

Chapter 5

Language Sampling


Dubé, 2005). For some children at least, wordless picture books seem to be a good resource for eliciting narratives. On the other hand, direct questions elicit the greatest number of different words (Gazelle & Stockman, 2003). Although question type does not seem to influence mean length of utterence (MLU) in toddlers, preschoolers respond with more multiword utterances following open-ended (What should we do next?) and topic-continuing questions (de Rivera, Girolametto, Greenberg, & Weitzman 2005). Settings should not be too contrived. Familiar, meaningful situations with a variety of ageappropriate and motivating activities provide greater variety and thus are more representative. Good settings for preschoolers include the free play mentioned earlier, snack time, and show-and-tell. Schoolage children can be sampled during group activities, class presentations, conversations with peers, and field trips. Generally, a child involved in some activity produces more language than a child who is watching others or conversing about pictures. It is better if the sample consists of two different settings in which different activities are occurring. The challenge for an SLP is to find a collection technique that strikes a balance. Too highly structured methods often are not representative (Fujiki & Brinton, 1987). Free play, although low in structure, may be time-consuming and result in variable unreliable data. It has been suggested that for older children, an interview technique is an effective alternative (Dollaghan, Campbell, & Tomlin, 1990). For 8- to 9-year-old children with SLI, the interview technique, although continued, yields more and longer utterances, more complex language forms, more temporal adjacency and semantic contingency, and more reliable, less variable results than free play (Craig & Evans, 1992). Conversational sampling should be authentic and functional (Damico, 1993). Authenticity comes from the use of real communication contexts in which the participants convey real information (Crystal, 1987; Damico, Secord, & Wiig, 1992; Douglas & Selinker, 1985). Functional sampling is most concerned with the success of a child with LI as a communicator. Success can be measured by effectiveness in transmitting meanings, fluency or timeliness, and appropriateness of the message form and style in context (Damico, 1991a; Kovarsky, 1992). The materials used should be interesting, age appropriate, and capable of eliciting the type of language desired. Interest can be piqued if a child is allowed to choose from a preselected group of toys or objects. Parents also can bring a their child’s toys from home in order to increase the validity of the sample. The selection of clinical materials can affect the pragmatic performance of young children by modifying the physical context in which the sample is collected (Wanska, Bedrosian, & Pohlman, 1986). This selection is especially important, given the current emphasis on the use of play in pragmatic assessment and intervention. When no toys are present, children are more likely to initiate memory-related topics (Bedrosian & Willis, 1987). In general, children around age 2 respond well to blocks, dishes, pull and wind-up toys, and dolls. Children around age 3 prefer books, clothes, puppets, and such toys as a barn with animals or a street with houses and stores. These toys encourage role-playing and language production. Kindergarten and early elementary school children respond best to toys with many pieces and to puppets and action figures. Finally, older children usually converse without the use of objects and can be encouraged to talk about themselves and their interests or to provide narratives. Narratives, a special type of language production, are discussed in Chapter 8. An SLP should consider the nature of the toys to be used in a play assessment (Wanska et al., 1986). For example, toys with construction properties, such as Legos, Play Doh, or clay, might be used to determine whether a child can remove the conversation from the present. Such toys are more likely to elicit more displaced topics, especially as objects are being constructed (R. S. Chapman, 1981).


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On the other hand, toys that encourage role-play might be used to elicit more verbalizations or vocalizations for objects, events, and actions. Compared with construction-type toys, a toy hospital elicits more discussion of the here and now and more fantasy topics and is more conducive to sociodramatic play and verbal representations of events and actions (Wanska et al., 1986). Toys also may assist in eliciting specific linguistic structures. For example, children are more likely to produce spatial terms in play with objects than in conversation. Object movement and manipulation can serve as nonlinguistic cues for a child. Because children’s cognitive knowledge and linguistic performance of spatial relationships may differ markedly, manipulation of toys can aid an SLP in assessing a child’s comprehension (Cox & Richardson, 1985; Harris, Morris, & Terwogt, 1986). The toys and positions should be varied so as not to suggest answers to children (Messick, 1988). If certain language features are desired, an SLP must increase the probability of their occurrence. With school-age children, discussion, rather than conversations based on pictures or toys in context, yields more mature language as measured by clause structure complexity, the ratio of hesitations to words, and grammatical and phonemic accuracy (Masterson & Kamhi, 1991). Because of the more complex language required in peer conflict resolution, these problems hold promise as a language sampling and intervention milieu for adolescents (Nippold, Mansfield, & Billow, 2007). In one model, a client is read a scenario concerning conflict between two young people. After this presentation, the client is asked to retell the scenario and to answer a series of questions on the nature of the conflict, why it’s a problem, and how it might be resolved by each character. Conversational Partners Because the SLP is interested in a child’s use of language, the unit of analysis becomes the conversational dyad of the partner and the child and their interactive behaviors in a given context (Prutting & Kirchner, 1983). The dyadic context enables an SLP to view a child’s communication within the applied situation of the natural environment. The importance of different partners is evident when we consider the conversations of adolescents. When teens talk to peers, they ask more questions, obtain more information, shift to more new topics, use more figurative expressions, and make more attempts to entertain than when they talk with their families (Nippold, 2000). Specific partners influence all aspects of communication. Conversational partners for young children should be carefully selected and instructed in their role. It is especially important to use familiar conversational partners with children under age 3 because these children often respond poorly to strangers. Parents of young children or children with acknowledged disabilities may need special instruction to avoid having their children “perform.” Uninstructed parents may feel compelled to quiz their child or to have their child recite stereotypic verbal routines such as nursery rhymes to enhance the child’s linguistic output. The problem with such recitations is that they may have little to do with the conversational abilities of a child. In general, it is best to involve a parent or caregiver and a child in some activity. Caregivers can be instructed to talk about what they and the child are doing. As mentioned, toys such as doll houses, action figure play sets, farms and towns, and puppets encourage interaction and role play. Familiar conversational situations are chosen as well to attain the most typical spontaneous sample in which a child is conversing as naturally as possible. Interaction may involve one adult or child or a small group of children engaged in sharing, playing, or working in the home or the classroom. A child should be assessed across several familiar persons with different interactive styles because of the effect that conversational partners—either individually or in small groups—have on the child’s

Chapter 5

Language Sampling


verbal output (Mirenda & Donnellan, 1986). For example, peer interaction usually involves more equal status between participants than do adult–child interactions. Adults tend to guide and control the topic when conversing with children, whereas child–child conversations are presumably more equal. As one might expect, these two conditions result in very different interactive styles for a child. If two children are talking, the adult should leave the room because children who are unsure of the situation will defer to the adult and thus skew the data. The language performance of children below age 3, of minority children, and of children with LD may deteriorate in the presence of an authority figure such as an unfamiliar adult. This does not mean that an SLP cannot act as a conversational partner. In many ways, an SLP may be the best conversational partner because of his or her knowledge of language and of interactions. The SLP and all other participating adults need to be mindful of the inherent problems in adultchild conversations and act to reduce the authority figure persona. The adult can accomplish this by accepting the child’s activity, agenda, and topics and by participating with the child. The best way to attain a semblance of equal authority is for the SLP and the child to engage in a play interaction. Instead of being directive, the SLP comments on and participates in their ongoing shared activity. With young children, participation may necessitate using the floor for play. As the conversational partner, the SLP can set the tone of the interaction by being nondirective, interesting, interested, and responsive. The SLP should respond to the content of the child’s language, not to the way it is said. At this point, the purpose is to collect data, not to change behavior. Our goal is collecting, not correcting. By manipulating the situation skillfully, an SLP can probe for a greater range of information. Initially, interaction may be dampened because the SLP is not the child’s usual communication partner. Therefore, it is important for the SLP to get acquainted slowly and in a nonthreatening manner. This task is best accomplished by meeting a child on his or her terms through play and by following the child’s lead. SLPs possess the clinical skill to elicit a variety of functions, introduce various topics, and ask questions about experiences. Role-play, dolls, and puppet play provide information about a child’s event knowledge in a range of situations. There is the potential to elicit a greater variety of language than might be possible when the child and parent communicate. Children who are reluctant to talk to adults may be more willing to interact with a puppet or a doll. I have found that small animals, such as guinea pigs, make excellent communication partners for children. For example, after explaining to a child that she must leave to run a short errand, the SLP introduces the guinea pig and asks the child to talk to it so that it will not get lonely. The child should be observed and his or her language recorded while the SLP is absent. Despite conventional wisdom, neither the race of the conversational partner nor the race depicted in stimulus materials seems to affect language performance as measured by response length and response latency (H. Seymour, Ashton, & Wheeler, 1986). This is not to say that all children, particularly children with CLD backgrounds will be unaffected. SLPs should be aware of potential difficulties and should approach each child with an open mind. Racial incompatibilities should not be expected, but all SLPs should be conscious of this potential. Topics Children have a wide variety of interests, and the conversational partners must be careful to enable a child to talk about them. Children are more spontaneous and produce more language when they are allowed to initiate the topics of discussion.


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An SLP should be prepared to shift topics as readily as activities. Therefore, an SLP must be conversant in topics of interest to children, such as school activities, holidays, movies, television programs, fads and fashions, videogames, and music. Summary Child variables, such as recent past experience and mood, can greatly affect language sampling, because the child is often the initiator in this protocol and because there are few performance constraints (Hess, Sefton, & Landry, 1986; Klee & Fitzgerald, 1985). To get the most representative sample possible, therefore, an SLP should use familiar situations, persons, and tasks or topics. Representativeness is enhanced if the conversational sample is collected in more than one setting, with different conversational partners and tasks or topics in each. Guidelines are summarized in Table 5.1. It may be helpful to think of interactional situations along a continuum from relatively nondirected or free to more controlled or scripted (Coggins, 1991; Shriberg & Kwiatkowski, 1985). Such toys as a dollhouse, a farm, action figures, bubbles, or dress-up clothes are rather open-ended, especially when a partner has suggested, “Let’s talk and play with these things.” Books or Colorforms offer more control and can be used to elicit particular words, forms, and narratives. Familiar routines, such as doing the dishes, also can be used, along with such cues as “What are you going to do now?” to elicit more specific behavior. Interviews, picture labeling, and responding to questions offer the most control but at the sacrifice of spontaneity and representativeness. These latter techniques are more appropriately considered evocative techniques used to elicit specific behaviors. Table 5.2 presents contextual variables that can be manipulated in an assessment to influence a child’s performance. Each variable can be modified to offer minimal or maximal contextual support (Coggins, 1991). Sampling should engage children in challenging interactions that stretch their language and reveal deficits (Hadley, 1998b). This requires a range of interactive situations and discourse types, including conversation, play, narration, and expository or factual/causal communication. EVOCATIVE CONVE R SATIONAL TECH N IQU ES Although the sample should represent everyday language use, free samples may have limitations, such as low frequency or nonappearance of certain linguistic features and conversational behaviors (F. Roth & Spekman, 1984b). Absence or low incidence does not mean a child lacks these features or behaviors. Therefore, it may be necessary to supplement the sample with evocative procedures specifically designed to elicit them. Test protocols also might be modified to obtain more structured samples (Thomas, 1989). An SLP may need to plan both the linguistic and nonlinguistic contexts for elicitation of various functions and forms. This requires planning and forethought. For example, infinitive phrases not only TABLE 5.1

Ensuring Representativeness in a Conversational Sample

Keep it spontaneous


Less clinician control


Less clinician contrivance


Less conscious child

Conversational partners Topics

Chapter 5


Language Sampling


Continuum of Contextual Support


Minimal Contextual Support

Maximal Contextual Support

Nonlinguistic Interaction Materials Interactor Activities

Naturalistic No toys or props Clinician Novel

Contrived tasks Familiar and thematic Mother/caregiver Event routines

Linguistic Cuing

Indirect model

Elicited imitation

Source: Coggins, T. E. (1991). Bringing context back into assessment. Topics in Language Disorders, 11(4), 43–54. Reprinted with permission.

are difficult for children with LI but they also require specific evocative techniques (Eisenberg, 2005). Infinitives come in two varieties, noun-verb-to-verb (John wants to go) and noun-verb-noun-to-verb (John wants Fred to go). An SLP can use play with dolls or puppets and have a child complete sentences within the play in the following manner: The cat says, “Can I eat?” The cat wants . . . You finish the story. The cat . . . ? The boys says to the girl, “Swim with me.” The boy asks . . . You finish the story. The boy . . . ? Early developing infinitives accompany verbs such as ask, forget, go (gonna), have (hafta) (gotta), like, need, say, suppose, tell, try, use, want. At first, some procedures may seem stiff and formal, even forced. Initially, the SLP may need to role-play the sampling situation and memorize conversational openers and replies. Once familiar with the many ways of eliciting a variety of functions and forms, an SLP can relax and use the techniques more naturally as opportunities arise within the interaction. Specific tasks that are within a child’s experience also can be used to elicit specific language forms (F. Roth & Spekman, 1984b). This approach allows a broad range of pragmatic functions to occur. For example, a mock birthday party can be used to elicit plurals, past tense, and questions (Wren, 1985). The SLP might elicit plurals by saying the following: Today is X’s birthday. Let’s have a party. What are some things we’ll need? (Or, Here are some things we need. What are these?) The child’s utterances are placed within context in which they make sense. Within the same situation, past tense might be elicited by dropping dishes and asking what happened or by reviewing whether you did everything to get ready (“Okay, now tell me what you did to get ready for the party. I washed the dishes”). Finally, questions can be elicited by a party game variation of Ask the Old Lady. Let’s play a question game. This is X (puppet, doll, action figure). I want you to ask X some questions about his birthday party. I wonder how old he is. You ask him. The child may need a demonstration before being able to complete the question task. Specific procedures and activities can be used to elicit a variety of communication intentions, examples of presupposition, and the underlying social organization of discourse within a variety of


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Situations with the Potential to Elicit a Variety of Language Functions



Playing house or farm

Playing school

Dolls, puppets, adventure or action figures

Acting out stories, television shows, movies

Farm set or street scene

Imaginary play

Simulated grocery store, gas station, fast-food restaurant, beauty parlor

Simulated TV talk show

situations. Table 5.3 lists examples of situations that each elicit a variety of language functions. In addition, SLPs are interested in ways to elicit various semantic and syntactic features. These elicitation techniques are presented in the following section. Intentions or Illocutionary Functions Illocutionary functions are the intentions of each utterance. Most utterances clearly demonstrate the speaker’s intent. “What time is it?” demonstrates a desire for information. However, the relationship is not always so obvious. “What time is it?” might be used as an excuse. For example, the speaker who does not wish to do something and knows that time is limited might use this utterance to establish the time factor for other people. Well, I don’t know . . . , it’s getting late. What time is it? Oh, well, I really better be going. Utterances also may express more than one intention. For example, the speaker might respond to a piece of art with “What do you call that thing?” Here, the speaker requests information and also makes an evaluation. Scripted elicitation protocols can target several communication intentions and conversational devices within different structured activities. Table 5.4 presents an outline of the two protocols (Creaghead, 1984). Some intentions are responsive in nature, for example, answering a question or following a directive or request for action. In addition to a child’s production level of such requests, it is helpful to know the child’s level of response (F. Roth & Spekman, 1984b). With responsive functions, an SLP must not interpret noncompliance as noncomprehension. A child simply may not want to comply or may choose to ignore the request. My granddaughter is especially good at ignoring. Come to think of it, so was her mom. An SLP first should be certain that the child can perform the behavior requested. The ages at which children comprehend different levels of requests are listed in Table 5.5. It might be helpful for the SLP to use two children in an ask-and-tell situation so that each child can act as a model for the other. In a similar manner, an SLP and child can switch roles as questioner (or director) and respondent. These are just a few suggestions for eliciting a variety of communication intentions. An SLP must note the type of intentions displayed, their forms, the means of transmission, and the social conventions that affect these means. For example, some situations may call for the use of nonverbal means; others may not. The following are a broad range of intentions and accompanying activities that may elicit language functions or intentions within a conversational or situational context.

Chapter 5


Language Sampling


Elicitation Protocol for Communication Intentions and Conversational Devices

Test Procedures—Format 1

Test Procedures—Format 2

As child enters the room—check GREETING Have cookies and crackers in jar within child’s view but out of reach—check REQUEST FOR OBJECT Hand child the tightly closed jar containing the cookies—check REQUEST FOR ACTION (help opening the jar) Ask child, “How do you think we can get the jar open?”—check HYPOTHESIZING Say “Do you want ‘mumble’?”—Check REQUEST FOR CLARIFICATION Ask the child if he or she wants peanut butter or jelly on a cracker—check MAKING CHOICES Hand the child the opposite of what was chosen— check DENIAL Put the peanut butter and jelly on the table. Ask the child, “What are we going to do now?”— check PREDICTING Tell the child to put peanut butter or jelly on the cracker—check REQUEST FOR OBJECT (knife) Tell the child to get the knife, which is not in sight— check REQUEST FOR INFORMATION Put the peanut butter and/or jelly on the cracker and eat it. Get out extra big toothbrush and pretend to brush teeth—check COMMENT ON OBJECT Hold a conversation with the child. During this, pull invisible string so that my doll falls off the table—check COMMENT ON ACTION Ask the child, “What happened?”—check DESCRIBING EVENT Ask the child, “Why did it fall?”—check GIVING REASON During conversation—check ANSWERING, VOLUNTEERING TO COMMUNICATE, ATTENDING TO THE SPEAKER, TAKING TURNS, ACKNOWLEDGING, SPECIFYING A TOPIC, CHANGING A TOPIC, MAINTAINING A TOPIC, GIVING EXPANDED ANSWERS Stop leading the conversation and be silent—check ASKING CONVERSATIONAL QUESTIONS Request clarification—check CLARIFYING

As child leaves the room—check CLOSING Give the child and yourself a piece of paper and tell the child to draw “mumble”—check REQUEST FOR CLARIFICATION After clarifying, do not give the child a crayon—check REQUESTING AN OBJECT Ask the child if he or she wants a red or blue crayon— check MAKING CHOICES Put on big glasses and then show the child a picture of a person and call it a dog—check COMMENTING ON OBJECT and DENIAL Ask the child, “Do you want to play with ‘mumble’?”— check REQUEST FOR CLARIFICATION Tell the child to get the telephones, which are not in sight—check REQUEST FOR INFORMATION Ask the child, “What are we going to do?”—check PREDICTING The tester calls the child, then the child calls the tester on the telephone—check GREETING and CLOSING Hold a conversation with the child. During this, make a remote-controlled toy move. The toy should be out of the sight of the tester and covered with a cloth— check COMMENT ON ACTION Ask the child, “What happened?”—check DESCRIBING EVENT Ask the child, “What do you think is under the cloth?”— check HYPOTHESIZING Ask the child, “Why did it move?”—check GIVING REASON Make the toy move briefly—check REQUEST FOR ACTION During conversation—check ANSWERING, VOLUNTEERING TO COMMUNICATE, ATTENDING TO THE SPEAKER, TAKING TURNS, ACKNOWLEDGING, SPECIFYING A TOPIC, CHANGING TOPIC, MAINTAINING A TOPIC, GIVING EXPANDED ANSWERS Stop leading conversation and remain silent—check ASKING CONVERSATIONAL QUESTIONS

Note: These protocols may be used as suggested scripts for efficient elicitation of several communication intentions and conversational devices. Source: Creaghead, N. (1984). Strategies for evaluating and targeting pragmatic behaviors in young children. Seminars in Speech in Speech and Language, 5, 241–251. Reprinted with permission.


Part 2

TABLE 5.5 Age in Years

Communication Assessment

Age and Comprehension of Requests



I need a _______. Give me a _______.


Could you give me a _______? May I have a _______? Have you got a _______?


He hurt me. (Hint) The _______ is all gone. (Hint)


Begin to comprehend indirect requests: Why don’t you _______ or Don’t forget to _______. Mastery takes several years.


Inferred requests in which the goal is totally masked are now comprehended. In this example, the speaker desires some juice: Now you make breakfast like you’re the mommy.

Source: Adapted from Ervin-Tripp (1977).

Answering/Responding An SLP asks a child a variety of questions while engaged in play (“Where shall we put the houses?”“Who is that?”“What’s in his hand?”) and notes the type of question and the expected response. Some question forms may be easier or more difficult for a child to respond to. Calling/Greeting An SLP leaves and reenters the situation, role-plays people entering and leaving a business, calls on the telephone, or uses dolls, puppets, or action figures to elicit greetings. If the SLP turns away from the child with a favorite toy, the child also may call. Continuance Continuance is turn filling that lets a speaker know that a listener is attending to the conversation. Typical continuants include “uh-huh,” “yeah,” “okay,” and “right.” These can be observed throughout the session. The SLP notes when the child seems to rely on this function, rather than contribute anything new or relevant to the conversation. Expressing Feelings An SLP models feeling-type responses throughout the play interaction. Dolls, puppets, or action figures are described as having certain feelings and the child is asked to help. For example, the SLP could say, “Oh, Big Bird is sad. Can you talk to him and make him feel better?” Hypothesizing An SLP poses a physical problem for a child, such as,“How can we get everyone to the party on time?” or, “How can we get Leonardo out of the cage?” The child proposes solutions to the problem. Making Choices An SLP presents a child with alternatives, such as,“I don’t know whether you’d rather have a peanut butter sandwich with jelly or fluff.” Predicting In sequential activities or book reading, an SLP can ponder, “I wonder what will happen now” or, “I wonder what we’ll do next.” Protesting An SLP can elicit protesting by putting away toys or taking away snacks before the child is finished. When a child requests an item, an SLP can hand the child something other than what was requested.

Chapter 5

Language Sampling


Reasoning An SLP attempts to solve a problem, such as, “I wonder why the boy ran away” or, “I wonder what we did wrong.” Repeating An SLP should note the amount of repetition of self and of the partner. This can take the form of empty comments in a conversation in which a child adds no new information, for example: Adult: Did your class go to the zoo yesterday? Child: Yeah, zoo. Adult: What did you like best? The monkeys? Child: Monkeys. Adult: Monkeys are my favorite too. They’re so funny. Child: Monkeys funny. Replying An SLP should note occasions when a child responds to the content of what he or she has said without being required to do so. This behavior is one of the mainstays of conversation as each speaker builds on the comment of the previous speaker. Reporting Reporting can include several functions. Declaring/Citing. While engaged in an activity, a child spontaneously comments on the present action. The SLP can model this behavior (“Car goes up the ramp”) but not attempt to cue a response because declaring/citing is spontaneous. The SLP also can engage in unexpected or unusual behavior and await the child’s comment. Detailing. An SLP presents a child with two objects of different size or color. If the child takes one and says nothing, the SLP models (“I’ll take the little one” or “Here’s a green truck”) and presents other objects later. The SLP does not attempt to cue a response because detailing is also spontaneous. Naming/Labeling. An SLP presents a novel object or points to pictures in a book and remarks,“Oh, look.” If the child does not label the object or picture, the SLP models the response (“Look. A clown.”) and goes on. The child may do so on subsequent exposure to other novel objects. The SLP does not cue a response because labeling like the other forms of reporting should be spontaneous. Requesting Assistance/Directing An SLP presents interesting toys in a way that requires adult help to open or use, such as objects in clear plastic containers or drawstring bags that require help to open. • Placing Giving the child one portion of a toy while keeping the other on a shelf. • Letting windup toys run down. • The SLP makes such comments as,“I wish we could play with this; it would be fun,”“Oh, we could use more parts,” or “Gee, we need to fix that.” In another situation, the child helps two puppets or dolls solve a problem in which one will not share a special toy with the other. The SLP also can present the child with situations that require a solution, such as toys with missing pieces. During interactions the SLP should note self-directing or self-talk accompanying play. This behavior can be modeled for the child, but it should be spontaneous on the child’s part. Requesting Clarification This intention can be elicited when an SLP mumbles or makes an inaccurate statement.


Part 2

Communication Assessment

Requesting Information An SLP places novel but unknown objects in front of a child. Naming the object correctly is the naming labeling function and the SLP should confirm the child’s name. If the child labels incorrectly, the SLP says, “No, it’s not an X,” “No, can you guess what it is?” or “How can we ask what it’s called?” The responses “What’s that?” or “What?” and those with rising intonation (“Frog?”) should be considered requests for information. The child can also be directed to ask others. Requesting Objects An SLP exposes the child to enticing objects or edibles that are just out of reach. The SLP also might direct the child to use an object not present in the situation or not in the expected location. If prompting is required, the SLP can ask,“Do you have the scissors?”When the child answers negatively, the SLP can direct the child by saying, “Ask Sally if she does.” Requesting Permission An SLP hands an interesting object to a child and says, “Hold the X for me.” The technique is more effective if the SLP uses a nonsense name for the object. The SLP then awaits a response from the child, such as, “Can I play with X?” or just, “Play X?” An even more effective technique is to keep the object hidden in an opaque box. The SLP peeks into the box and tells the object that it can come out to play when someone wants to play with it. If necessary, a puppet can model the requesting behavior desired. Presuppositional and Deictic Skills Whereas intentions are noted at the individual level, other linguistic aspects, such as presupposition and deixis, underlie the entire conversational interaction. Presupposition is the speaker’s assumption about the knowledge level of the listener and the tailoring of language to that supposed level. Deixis is the interpretation of information from the perspective of the speaker. When a speaker says, “Come here,” this must be interpreted as a point close to the speaker, not as a point with reference to the listener. Deictic terms include, but are not limited to, here/there, this/that, come/go, and you/me. Presuppositional and deictic skills can be assessed in referential communication tasks (F. Roth & Spekman, 1984b). In classic referential tasks, one partner describes something or gives directions to the other partner, who is usually on the other side of an opaque barrier or unable to see the speaker (see Figure 5.1). Variations include blindfold games or telephone conversations. As a rule, preschoolers perform better if describing real objects rather than abstract shapes. Deixis can be elicited by using objectfinding tasks in which the child directs the conversational partner toward a hidden object. In these tasks, an SLP must be alert to the use of direct/indirect reference. In direct reference, the speaker considers the audience and clearly identifies the entity being mentioned. Indirect reference typically follows direct reference and refers to entities through the use of pronouns or such terms as that one. A child with poor presuppositional skills may use indirect reference without prior direct reference. Additional presuppositional information can be gathered by varying the roles, topics, partners, and communication channels available in the sampling situation. Roles can be varied so that a child has an opportunity to act as listener and speaker. Assessment of both roles is essential. For example, a child with LD generally will ask few questions for clarification even when he or she has little understanding of what has been said. As speakers, these children make limited use of descriptors, provide very little specific information, and are less effective than children developing normally. The choice of topics also can influence presuppositional behavior and provide for a variety of role taking. Children can be asked to describe events about which the SLP or partner is ignorant (e.g., a family outing). In this situation, the child must determine the amount of information necessary for the listener to understand the topic. The partner who asks the child to explain something that the partner

Chapter 5

Language Sampling


FIGURE 5.1 Barrier tasks.

already understands violates the principle that communication should make sense. There is no sense in explaining something that someone already understands. As the number of communication channels decreases, a speaker is forced to rely more heavily on the remaining ones. For example, the use of a telephone requires the speaker to rely almost exclusively on the verbal communication channel. This situation is a challenge even for some nonimpaired language users. While gathering the language sample, an SLP can manipulate channel availability systematically. During play, an SLP can look away and then ask the child to describe what he or she is doing. Barrier games or blindfold games with the child in charge also may elicit interesting information; however, roleplaying with the telephone is more realistic. Several other activities can be used to elicit presuppositional skills. Of interest is whether a child can encode the most informative or uncertain elements in a situation. In general, human beings tend to comment on entities and events that are new, changing, or unexpected. In the sampling situation, novel items can be introduced. The SLP must attend to the child’s behavior to see whether the child refers to the novel stimulus. I know of one clinic where a kitten is abruptly introduced into the sampling situation. The SLP says nothing but waits to see whether the child will comment and in what manner. In general, young children with LI encode novel information less frequently than do children developing typically. Older school-age children with LI tend to use more pronouns with less identification of the referent than do children developing typically. Games and stories can elicit indirect/direct reference. For example, a story can be told and then questions asked to elicit indefinite and definite articles and/or nouns and pronouns. The child also can retell a story to a second child who has not heard it. Any portion of extended discourse, such as describing a movie, explaining how to accomplish a task, or telling a story, will be valuable clinical data (F. Roth & Spekman, 1984b). The SLP is interested in both the lexical items used and the ambiguity of the referent. Of interest is the number of times the child mentions the referent by name or by the use of pronouns. Some children overuse the referent name (“The boy . . . , The boy . . . , The boy . . .”), whereas others rely on the pronoun without sufficient return to the referent name to avoid confusion (“He . . . , He . . . , He . . .”). Finally, role-playing activities with very specific situations also can be helpful. The child in the following situation faces very definite behavioral constraints.


Part 2

Communication Assessment

Imagine you and a friend are trying to find a drinking fountain. You see a man coming down the street. While your friend remains seated on a park bench, you try to find out about the fountain. I’ll be the man. What would you say? (Child responds.) Now, I’m your friend. What would you tell me? Discourse Organization Discourse has internal organization. For example, a telephone conversation has a recognizable pattern, as does the telling of a personal event. The social organization of discourse can be assessed within familiar activities that provide a scaffolding or structure for dialogue (F. Roth & Spekman, 1984b). An SLP may be interested in the amount of social and nonsocial speech. For example, preschool children frequently engage in nonsocial monologues in play, in contrast to older children, who participate more in dialogues or in social monologues. This change signals a growing awareness of the social nature of speech and language use. An SLP can provide opportunities for a child to initiate conversation, to take turns, and to repair in response to self-feedback or the feedback of others in different situations. Turn taking may need to begin at a physical level with some reticent children. In conversation, an SLP might even say, “Now it’s your turn,” and point to the child initially. By failing to respond to the child or by responding inappropriately, mumbling, failing to establish a referent, misnaming, or providing insufficient information, an SLP may elicit requests for clarification from a child. Semantic Terms Relational terms, such as in front of, more/less, and before/after, are especially difficult for children with LD and other forms of LI. These children often use comprehension strategies that have several implications for assessment (Edmonston & Thane, 1992). For locational terms, these strategies may include probable location, physical properties of objects, and preferred location. Adjectival relational words, such as big and little, may be comprehended by using either a preference for amount or word synonymity. With temporal terms, strategies may include sequential probability and order-of-mention or main-clause-first. Each of these strategies is explained below. It is easier for children to comprehend locational terms and to follow locational instructions when familiar objects are combined in familiar, predictable, or probable ways, such as juice in a cup. Levels of comprehension can be determined by using the usual, or “normal,” context or a “contextually neutral” context in which object placement is not so predictable (Lund & Duchan, 1993). The physical properties of an object can also influence responding. A child’s rule may be, Containers are for in, and surfaces are for on. Square containers can be turned on their sides by the SLP and used for both in and on. Other objects may be used with different terms (Edmonston & Thane, 1990). Some objects are fronted or have an obvious front, such as a TV, while others, such as a wastebasket, are not. This characteristic affects comprehension and production of such terms as in front of and behind. In general, these terms are easier to use with fronted objects than with nonfronted objects. In addition, some young children interpret behind to mean hidden from view by, so they will place a small object correctly with large nonfronted objects (J. Johnston, 1984). Obviously, in front of and behind must be assessed with fronted and nonfronted and small and large objects (Edmonston & Thane, 1992).

Chapter 5

Language Sampling


With deictic terms, young children may employ either a child-centered or speaker-centered strategy, preferring that location as the reference point (Wales, 1986). Assessing contrastive terms, such as here/there, with different speakers may be help determine if such preferences exist. Adjectival terms, such as more/less, long/short, and big/little, may be interpreted by using a preference for a greater-amount strategy in which a child usually chooses the largest one when in doubt. Assessing both words in different contexts and in different word order may help an SLP understand a child’s errors. Similarly, height of the objects used affects comprehension of such words as big, tall, top, young, and old (Coley & Gelman, 1989; Harris et al., 1986; Hobbs & Bacharach, 1990; Sena & Smith, 1990). Preschoolers often equate big with tall and old and little with short height and young. Objects can be placed so that their heights are similar by using stands of different heights. Some children use a strategy in which they interpret contrastive terms such as big and little to be synonymous or assign the meanings to similar terms. In the latter, big becomes synonymous with tall, wide, and thick. Object dimensions can be controlled so that, for example, the widest objects are not always the biggest overall. Finally, as mentioned, temporal sequential terms, such as before and after, may be interpreted by using a most probable, order-of-mention, or main-clause-first strategy. In the most probable strategy, a child trusts experience. Among preschoolers, this is the most widely used strategy with familiar, realworld sequences (Keller-Cohen, 1987). Order-of-mention, or the first-action-mentioned-occurredbefore-the-second, is also popular among preschoolers, while children over age 5 often use the main-clause-first strategy in which the main clause of the sentence is assumed to have occurred first. For example, in the sentence “After finish school, we can go to the rec center,” a child may assume the rec center occurs first. Sequential terms should be note when used as both prepositions, as in after school, and conjunction, as in she did X after she did Y. Language Form An SLP can manipulate the context to elicit particular forms. For example, the objects and the verbal routines chosen for play may facilitate the use of pronouns or prepositions. Specific syntactic forms, such as verbs, and morphological markers, such as the regular past-tense -ed, also can be elicited in creative ways. Some intentions discussed previously in this chapter, such as requesting information, have specific linguistic forms. A few elicitation methods for specific structures are listed in Table 5.6 (Crais & Roberts, 1991).

LANG UAG E SAM PLI NG OF CH I LDR E N WITH CLD BACKG ROU N DS It is even more important that the language of children with CLD backgrounds be collected in several different contexts (Damico, 1991b; Iglesias, 1986). Code switching and differing language and dialect use in context is extremely important information for determining the effectiveness of a child as a communicator. Sampling should occur in monologue and dialogue situations in both languages or dialects. Monologue activities might include static, dynamic, and abstract tasks. Static tasks describe relationships among objects in the context and might include directing others to perform a task or describing entities by location, size, shape, or color. Dynamic tasks describe changes over time as in narration. Finally, abstract tasks might include opinion-expressing tasks, such as stating or justifying a position.


Part 2


Communication Assessment

Elicitation of Some Language Features


Elicitation Technique

Prepositions Nouns, verbs, etc.

Hide objects and have the child try to guess their location. Ask specific Wh- type questions: What’s that? for nouns. Where’s X? for prepositions. What’s John doing? or What did (will) Mary do? for verbs. How does Carol feel? or How did Martin do X? for adjectives and adverbs. Play games with many parts, such as Mr. Potatohead or Colorforms and have the child request desired pieces (I want the ears). Use similar objects of different sizes and colors. Ask child, What do you want? Play dress-up and ask, Whose dress is this? Play I Spy (I spy something and he’s big). Play Twenty Questions and I Spy. Play Hide-and-Seek and other guessing games (What’s in the bag? Where’s the bull?).

Plural -s marker Adjectives Possessive pronouns Subjective pronouns Yes/no questions Wh- questions

Source: Crais, E. R., & Roberts, J. (1991). Decision making in assessment and early intervention planning. Language, Speech, and Hearing Services in Schools, 22, 19–30. Reprinted with permission.

Dialogue situations should include a variety of partners because of the special constraints that each imposes on a child with a CLD background. The classroom is especially important because of the academic difficulties these children may encounter. In each context, different conversational partners can pose communication problems for a child. Change and problem solving encourage communication and enable an SLP to determine the effectiveness of the child as a communicator. In addition, such situations can offer clues to the learning style of the child (Iglesias, 1986). Guidelines for collecting a language sample from children with CLD backgrounds are presented in Table 5.7.

Recording the Sample There is no ideal length for a conversational sample. Length varies with the purpose of collection. For example, a 50-utterance sample may be adequate for lexical evaluation because it will contain 73 to 83 percent of the lexical information found in a 100-utterance sample (Cole, Mills, & Dale, 1989). Although 50 or 100 child utterances are considered adequate, providing there is some variety of setting, partners, tasks, or topics and that other data collection methods are used, at least two different samples should be included (Cole et al., 1989). For example, one 15-minute or 50-utterance sample is insufficient for measuring Brown’s Fourteen Morphemes (Balason & Dollaghan, 2002). Remember them for your language development course? At best, even with two samples, an SLP may obtain only enough data to confirm the stage of development and to validate the mean length of utterance (MLU) (described in Chapter 7), but this is insufficient to adequately describe use patterns from which intervention goals can be determined. Occasionally, children fall into repetitive patterns of responding, such as naming pictures in a book. This kind of activity provides very little variation in a child’s behavior. It is best either to limit

Chapter 5


Language Sampling


Guidelines for Language Sampling with CLD Children

Observe the child in various communication contexts, especially low-anxiety, natural communication environments. Observe the child with speakers of both languages or dialects. Language mixing during collecting may confuse the child. Record conversations with the child’s family for comparison. Explore with the family the child’s communication in the home and community environment. Use culturally relevant objects to stimulate conversation. Pictures should contain members of the child’s racial/ ethnic group. Avoid the tendency to “fill in” for the child’s communication gaps. Observe the child’s strategies for getting the message through. Note: Language uses and purposes. How flexible is the child’s system? Success at communicating. Are certain content and situations more successful? Communication breakdowns. Where do they occur? With whom? Strengths and weaknesses. What strategies are used to compensate for weakness? Anxiety and frustration. Source: Compiled from Battle (1993); Roseberry-McKibbin (1994); Stockman (1996).

this type of interaction or not to use it for analysis. If, on the other hand, a child frequently exhibits perseverative or stereotypic patterns, they should be recorded for analysis, saved for supporting data, or commented on in the assessment report. A language sample is recorded permanently by using an a log or digital recording, event transcription, or a combination of these (F. Roth & Spekman, 1984b). Samples can be recorded digitally on your MP3 player for listening or transferred to a computer for listening and transcription. Audio recording is essential because the interaction must be reviewed repeatedly for information. Although videorecording can be intrusive and expensive, especially the initial equipment purchase, it yields the best data for describing the verbal and nonverbal behaviors observed. You could even use your webcam if you have recording software. The alternatives to videotaping are not as reliable and thus increase the variability in the behavior recorded. Even if video is used, the SLP may find a simultaneous audio recording helpful for transcribing the speech and language portion. The following recording methods are listed in order of decreasing desirability: 1. Simultaneous video and audio recording. 2. Simultaneous audio with SLP descriptions of nonlinguistic behaviors recorded in one device and the linguistic interaction in the other. 3. Simultaneous audio recording and written-data recording on time sheets (see Table 5.8). Having more than one observer may help ensure that no behaviors are overlooked and may increase the reliability of description of those that are observed. Writing data as the interaction progresses is extremely tedious but necessary for some analysis. It is important for later transcription that different data collection methods begin at the same time. This should be accomplished as unobtrusively as possible. A cough or some similar signal by the SLP can alert observers that recording has begun but hopefully not alert the child being recorded.


Part 2


Communication Assessment

Time Form for Recording the Nonlinguistic Context Minute 2

Time (sec.)

0 . . . . 10 . . . . 20 . . . . 30 . . . . 40 . . . . 50 . . . . 60

Child’s Behavior

Partner’s Behavior


Looks at partner Points to truck

Reaches for truck Hands truck

Pushes car Looks at partner Points to gas station Moves car to gas station Moves car to gas station

Transcribing the Sample The conversational sample is transcribed as soon after recording as possible. This timeliness ensures that an SLP brings to the task as much memory of the situation as possible. The format of the transcript varies with the purpose of the assessment. For most purposes, the type of format shown in Table 5.9 is suggested. The use of computerized analysis programs, such as the Systematic Analysis of Language Transcripts (SALT), requires a consistent transcription format (J. Miller & Chapman, 2003) (see Appendix B). This format will include not only the utterances but also the symbols for the program to aid it in identifying morphological markers and syntactic categories. Usually, multiple analyses can be performed without reentering the transcript or with only minor changes to accommodate different transcription conventions and analytic capabilities (Long, 1991).

Chapter 5


Language Sampling


Transcription Format Minute 2

Time (sec.)

0 . . . . 10 . . . . 20 . . . . 30 . . . . 40 . . . . 50 . . . . 60

Child’s Utterances

Partner’s Utterances


What do you need now?

Can I have the truck?

C looks at partner C points to truck Which one?

That one Oh, the red one Okay Now can we go on vacation?

C reaches for truck P hands truck


C pushes car

We need gas first

C looks at partner C points to gas station Well then I’ll drive my car over, too

P moves car to gas station C moves car to gas station

What else do we need? Gotta get soda and chips

The SLP transcribes the linguistic behavior of both the child and the conversational partner, along with the nonlinguistic behaviors of each. The timesheet format in Table 5.9 enables the SLP to evaluate delays or latencies on the part of the child. All of the child’s utterances, including false starts, nonfluencies, and fillers, are transcribed. Although these linguistic elements may not be used for calculation of utterance length, they are extremely important in determining language and communication difficulties. All utterances of the conversational partner(s) also are transcribed. These are important in assessing the manner and style of the conversational partners. The SLP is interested in the amount of control and the amount and type of talking exhibited by the partner. Determining utterance boundaries is often difficult. This is not an exact science, and the artistry of an SLP is needed at this point. An utterance is a complete thought that is divided from other utterances by sentence boundaries, pauses, and/or a drop in the voice. Table 5.10 contains examples of utterance boundaries.


Part 2

TABLE 5.10

Communication Assessment

Utterance Boundaries

A sentence is an utterance. Mommy went to the doctor’s tomor . . . yesterday. Run-on sentences with and should contain no more than one and joining clauses. We went in a bus and we saw monkeys and we had a picnic and we petted the sheeps and one sheep sneezed on me and we had sodas and we came home. Utterances: 1. 2. 3. 4.

We went in a bus and we saw monkeys. (And) we had a picnic and we petted the sheeps. (And) one sheep sneezed on me and we had sodas. (And) we came home.

Other complex or compound sentences should be treated as one utterance. He was mad because his mommy spanked him because he broke the lamp and spilled the doggie’s water. Imperative sentences are utterances. Go home. Pauses, voice drops, and/or inhalations mark boundaries. Eat (pause and voice drop) . . . chocolate candy. Two utterances: Eat. Chocolate candy. Eat (momentary delay) . . . chocolate candy. One utterance: Eat chocolate candy. Situational and nonlinguistic cues help to determine boundaries. Eat (hands plate to partner insistently) . . . chocolate candy (points to candy dish). Two utterances: Eat. Chocolate candy. Want (reaches unsuccessfully) . . . mommy (turns to look). Two utterances: Want. Mommy. Want mommy (reaches unsuccessfully). One utterance: Want, mommy. The linguistic context also helps. Partner: Well, what do you want? Child: Candy (pause) . . . you get it. Two utterances: Candy. You get it.

Declaring sentences to be utterances is easy. Most of what is said, however, is not in complete sentence form. For example, the response to a question often omits shared information and might consist of such responses as “No,” “Cookie,” and “Okay.” Each of these is a complete utterance. Longer responses, such as “No, later” or “No, let’s go later,” are also single utterances. This determination might change if the child were to respond with a pause and a drop in the voice after “No.” “No (pause and drop voice). Let’s go later.” Now there are two utterances. Partial sentences or phrases, nonfluent units, and run-on sentences are even more difficult. A partial sentence might consist of the child pointing to an object and saying, “Doggie.” This would count

Chapter 5

Language Sampling


as an utterance. Parts of sentences may be strung together, as in the following exchange in which the child makes an internal repair: Partner: I like to play mommy. Child: No, you not . . . me the . . . you baby. The entire unit is an utterance and will be analyzed in different ways by using all or part of what the child said. For run-on sentences, the SLP can follow the general rule that allows two clauses to be joined together in a sentence with and. In the following example, sentence/utterance boundaries have been marked as they might be on a transcript: [I went to the party, and we ate pizza] [(and) We played games, and I won a prize] [(and) We had cake and ice cream.] Division can be aided by the child’s pauses and breath patterns. Children in the late preschool years often make long strings of clauses with and meaning and then. Counting these as a single utterance inflates the mean utterance length. Young children are less likely to form run-ons with other conjunctions. Once the sample is transcribed, it can be analyzed.

Collecting Samples of Written Language With school-age children and adolescents, an SLP also will want to collect samples of their written language. Underlying language processes make it imperative that an SLP sample all modalities. Collection and analysis of written samples is explained in more detail in Chapter 13. If a teacher suspects that a child has a language impairment, he or she should contact the school’s SLP, who can ask the teacher to compile a portfolio of the child’s written work. It should include first drafts of both narrative and expository writing. In addition the SLP should elicit a written sample as he or she observes the child. In addition to the writing, the child’s general demeanor, the presence of frustration, the amount of help needed, and the look and quality of the finished product will be of interest. The child’s written language can be compared to the spoken sample for similarities and differences. Of particular interest will be language features noted in the language of older children, such as cohesive devices, noun and verb phrase structure, illocutionary functions, vocabulary and word relationships, conjoining and embedding, along with spelling and penmanship. These will all be discussed in later chapters.

Conclusion Collecting a representative language sample that demonstrates a child’s diverse abilities is a difficult task. Careful planning and execution are required, as are exacting methods of recording and transcription. Although these procedures may seem difficult and time-consuming initially, they can be accomplished


Part 2

Communication Assessment

easily and relatively quickly with practice. A properly planned and executed sampling and a thorough transcription will yield an abundance of linguistic and nonlinguistic information. Guides for collecting a language sample include the following: a positive relationship with the child before recording the language sample. • Establish Reduce your authority-figure persona to ensure more participation by the child. A child is more • likely to respond naturally with someone who is an equal. Be unobtrusive while collecting the sample so that the child is less conscious of the process. • The conversational partner should keep talking to a minimum. Although SLPs abhor a vacuum, • when possible you should wait out the child when possible. Avoid yes/no questions and constituent questions (e.g., what’s that?) that require only a one-word • response from the child. Ask process rather than product questions (e.g., how do you do that?) Follow the child’s lead in play and in the selection of topic. Determine the child’s interests before • beginning the collection process. Select those materials at the child’s interest level that are likely

• •

to stimulate interest. If the child does not talk or responds in a very repetitive or stereotypic manner, model responses for the child or have another person model. Collect more than one sample.

Only through sampling the child’s linguistic abilities in a conversational context can the SLP gain insight into how a child’s language works for that child. This is the first step in designing intervention that is relevant to the child and thus more likely to generalize to use environments.



Analysis Across Utterances and Partners and by Communication Event


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Communication Assessment


anguage is complex, and the analysis methods used with a conversational sample reflect this complexity. You were afraid I’d say that, right? For this reason, analysis of a language sample should not be a fishing expedition for possible problems. Language analysis is best used to explore certain aspects of a child’s behavior brought into question through other data collection methods. If a language disorder exists, it can be confirmed by descriptive analysis of a sample of the child’s unique language pattern. Traditional analysis has focused exclusively on the utterance or sentence as the unit of analysis. Although this type of analysis is appropriate for many language features, it may not be the best way to assess behaviors that transcend these units. To analyze language only at the utterance level is to miss many of a child’s language skills, especially those aspects that govern cohesion and conversational manipulation. Only by going beyond individual utterances can an SLP gain an understanding of a child’s use of the many language skills (Biber, 1986; Scott, 1987). For example, an analysis of a child’s use of pronouns necessitates crossing utterance boundaries in order to describe the child’s introduction of new information (. . . a doggie) and reference to old or established information (He . . .) that may have been introduced by the child or the conversational partner. In this chapter, we explore analysis across utterances and partners and by communication event, noting the adjustments a child must make to meet conversational demands. These analyses are suggested when an SLP suspects difficulties. Obviously, the many types of analysis mentioned in this chapter would be too numerous to examine and too time-consuming to perform with every child. Because little normative information is available on conversational skills, analysis at these levels is largely descriptive. Table 6.1 presents some types of analyses possible across utterances and partners and by communication event.


Types of Analysis Beyond the Utterance

Across Utterances and Partners

By Communication Event

Stylistic Variations Register Interlanguage and Code Switching Channel Availability Referential Communication Presuppositional Skills: What Is Coded and How Linguistic Devices: Deictics, Definite and Indefinite Reference Cohesive Devices Reference: Initial and Following Mention Ellipsis Conjunction Adverbial Conjuncts and Disjuncts Contrastive Stress

Social Versus Nonsocial Conversational Initiation: Method, Frequency, and Success Rate Topic Initiation: Method, Frequency, Success Rate, and Appropriateness Conversation and Topic Maintenance: Frequency and Latency of Contingency Duration of Topic: Number of Turns, Informativeness, and Sequencing Topic Analysis Format: Topic Initiation; Type of Topic; Manner of Initiation, Subject Matter, and Orientations; Outcome; Topic Maintenance: Type of Turn; and Conversational Information Turn Taking: Density, Latency, and Duration Overlap: Type, Frequency, and Duration Signals Conversation and Topic Termination Conversational Breakdown Request for Repair: Frequency and Form Conversational Repair Spontaneous Versus Listener-Initiated Strategy and Success Rate

Chapter 6

Analysis Across Utterances and Partners and by Communication Event


It is important for an SLP to remember that many of the language features discussed in this chapter are dependent on the behavior of a child’s partner and vary with the situation and the culture of the child and the conversational partner (Crago & Eriks-Brophy, 1992). The stimuli and reinforcers and the child’s response to each, the conversational roles of each partner, and the type and amount of communication are contingent on cultural values. Tasks should be culturally relevant with functional, meaningful, culturally appropriate language. Sampling results should be analyzed with cultural variability in mind. For example, the cultural norm may be that adults do not respond quickly to children.

Across Utterances and Partners Analysis at the utterance level reveals much about a child’s discrete, finite language skills but may obscure a child’s knowledge of the “big picture,” the cohesion that threads through conversations. Some linguistic devices serve this cohesive purpose, and larger units than the utterance must be analyzed to assess their development. Other devices vary across whole conversations, and one sample may be very different from another. STYLISTIC VAR IATIONS The style of talking, whether formal, casual, or varied in other ways for the situation, usually does not change utterance by utterance. Rather, it is a manner of talking with a specific language partner or in a specific situation. Different styles also may be seen in role-play. An SLP may be interested in the different styles used by a child in the various samples collected. As early as age 4, children use a different style of talking when they address younger children learning language. This style resembles motherese or parentese, the stylistic changes made by parents when they address these same younger children. Mature language users have a variety of styles at their disposal and can switch styles with little effort. Such variation requires a speaker to consider the listener and the situation and the resultant requirements on the speaker. Register Style switching, the move from one style or register to another, must be judged against the age, gender, and language ability of the speaker and the listener. Styles differ according to role-taking characteristics, dialectal variations, amount of politeness, and conversational control. Conversational roles can be established by the topics chosen, vocabulary (dear, sir, honey), pronunciation, and the discourse style (formal, casual, playful, etc.) selected. Usually, the more dominant partner takes longer turns and asks more questions. The degree of politeness also varies. In general, speakers are more polite when in the less dominant role or when requesting something that belongs to or is controlled by the other partner, who may be unlikely to grant the request. Children with LD often fail to use registers based on differing situational variables. Data suggest that these children do not adjust to different speakers or may adjust in different ways from children developing typically. Children with LD may fail to recognize the characteristics of different settings. The child with LI may not be able to discriminate dominant from nondominant roles and the language form that goes with each. The most frequent problems with register include providing insufficient information for the listener, not knowing when to make a statement, asking inappropriate questions, giving insufficient reason for the cause and effect of a situation, and not adjusting register to the speaker


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Communication Assessment

(A. Johnson, Johnston, & Weinrich, 1984). It may be especially difficult for a child with LD to express feelings and emotions. These expressions may be very direct. An SLP studies the sample to determine the stylistic variations present. The value of collecting language samples in two very different but client-appropriate situations is apparent. The SLP should look for modifications in politeness, intimacy, and linguistic code based on the age, status, familiarity, cognitive level, linguistic level, and shared past experience of the listener (F. Roth & Spekman, 1984a). Of interest is the attention the child gives to the listener’s characteristics. In addition to noting stylistic variations, the SLP looks for inappropriate styles—those that are too formal, too casual, or include excessive swearing, for example. The SLP might note features such as differing utterance length with various partners. Other variations include vocabulary and topic. More subjective indices include intonational patterns and the use of attention-getting and maintaining devices. Interlanguage and Code Switching With children with LEP, it is important to establish patterns of language use in both L1 and L2 (Hamayan & Damico, 1991). Two possible patterns are called interlanguage and code switching. Interlanguage is a combination of the L1 and L2 rules, plus ad hoc rules from neither or both languages. This “hybrid” language varies among children and within an individual child across situations (Tarone, 1988). Usually, interlanguages are transitional in nature, but some features may stabilize as a permanent form, especially if there is little motivation to change. Predictable patterns should be identified during observation and sampling. Of interest are the rules used by the child and any situational variables. Linguistic code switching is the shifting from one language to another within and/or across different utterances. A complicated, rule-governed behavior, code switching does not signal poor language skills, although it may be used by children when they have inadequate L2 skills. As with interlanguage, code switching is influenced heavily by contextual and situational variables (Sprott & Kemper, 1987). For example, the Spanish-speaking storyteller might use English when referring to Anglos and Spanish when referring to Latinos. Code switching follows agreed-upon community rules and usually occurs to enhance meaning, emphasize a change of topic, and convey humor, ethnic solidarity, and attitudes toward the listener (Hamayan & Damico, 1991). The SLP should note uses of interlanguage and code switching, along with sampling variables such as the situation and the partner(s). It is especially important to identify patterns that may impede the transmission of meaning or interrupt communication. Channel Availability Most children below age 11 experience less communication success when they do not visually share the communication environment with their listener, as when on the phone (F. Roth & Spekman, 1984a). As the number of communication channels decreases, a child with LI should have increasing difficulty communicating. In fact, children with LD often have great difficulty if forced to rely solely on the verbal channel. The SLP should note in the sample the relative success of the child’s communication efforts as the number of channels varies. R E FE R E NTIAL COM M U N ICATION Referential communication is the ability of a speaker to select and verbally identify the attributes of an entity in such a way that the listener can identify the entity accurately (Bowman, 1984). To succeed, the speaker must be able to determine what information the listener needs, deliver that information

Chapter 6

Analysis Across Utterances and Partners and by Communication Event


in a specific manner, make comparisons, and use feedback on message adequacy and breakdown. While “He has brown hair” fails to communicate the referent, “The only boy in my history class has brown hair” succeeds. Referential communication includes directions, explanations, and descriptions. These are three essential aspects of classroom discourse, and their impairment may contribute to the academic difficulties of children with LD (Donahue, 1985). Presuppositional Skills Presupposition is a speaker’s assumptions about the context and about the listener’s knowledge that modify the manner and content of the speaker’s utterances (A. Johnson et al., 1984). The speaker must take the conversational perspective of the listener(s) and determine what information to communicate and its form. From early on, informativeness is a characteristic of communication. Even toddlers tend to code information that is maximally informative, thus talking about things that are new, different, and changing. For most children, the receptive and expressive ability to consider a partner’s perspective is well established by age 10. Although both comprehension and production require understanding of the critical features needed, production also requires knowing how and when to provide information. Children with LD have poor referential skills and are less likely to adjust to the listener and more likely to provide ambiguous and insufficient information. In addition, although children with LD seem to understand directions given by others, they take longer to comply than do age-matched children who are non-LD (Feagans & Short, 1986) and have great difficulty giving adequate instructions. An SLP should be alert to the informativeness of a child’s utterances and to the social context. The following questions can be applied to the sample (F. Roth & Spekman, 1984a): does the child choose to encode in the situation? • What Does the child encode what is novel or merely comment on what is already given? • Does the child encode new information gesturally or linguistically? • Are messages informative, vague, or ambiguous? • Are different referents clearly • Does the child talk differentlyestablished? about things present and things not? • What Is Coded and How Conversations usually contain information that is novel and informative. The SLP is interested in whether the child adds to the conversation or only comments on what is given. In the following exchange, the child takes a turn but adds nothing of substance to the conversation. Partner: Wasn’t that a great baseball game on TV last night? Child: Yeah, great game. Partner: What a great home run in the top of the ninth; I didn’t expect Cincinnati to pull it out. Child: Great home run. Partner: I think they’ll probably go on for the pennant. How about you? Child: Pennant. If this sounds like the conversation of someone who doesn’t know the topic well enough to comment, that may be partially correct. The child may not be able to identify the topic. Frequent repetition may indicate a semantic (word retrieval), processing, or pragmatic (not sure of the contextual demands) problem.


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Communication Assessment


Types of Noninformative Language

Empty phrases (common idioms, such as and so on and et cetera, excetera) Indefinite terms and highly nonspecific nouns (one, thing, that) Deictic terms (this, that, here, there) Pronouns used without antecedent nouns Comments on task instead of stimulus Neologisms (Oh, you know the one that you fly in) Paraphrases Repeated words or phrases Personal value judgments about the stimulus (That’s pretty dumb) Use of and alone Conjunctions but, so, or, and because alone Source: Adapted from Nicholas, Obler, Albert, & Helm-Estabrooks (1985).

Noninformative language can take several forms (Nicholas, Obler, Albert, & Helm-Estabrooks, 1985). Table 6.2 presents forms and examples seen in children with LI. These types of noninformative language may be especially useful when rating the language of children with TBI and LD. The SLP can rate utterances to determine the strategy used by the child. Linguistic Devices Several linguistic devices are used to mark informativeness, including deictics and direct/indirect reference (F. Roth & Spekman, 1984a). Both of these devices can be used to note referents internal or external to the conversation; other cohesive devices, listed in Table 6.3, establish relations entirely within the discourse. Deictics As mentioned in Chapter 5, deictic terms are linguistic elements that must be interpreted from the perspective of the speaker in order to be understood as the speaker intended. The use of deixis is TABLE 6.3

Cohesive Devices Used in English





Initially, the entity is named and may use the indefinite article (a/an). Subsequent mention may use a pronoun, words such as this, that, and one, or use the definite article (the) with the noun.

John went looking for a car. He found one in the city. I want to buy a coat, but that one I saw last night is too expensive.

Subsequent sentences omit redundant or shared information.

Who ate all the cookies? I did [eat all the cookies].


I would like to make a phone call. May I [make a phone call]? Conjunction

Conjunctions join clauses to express additive, causal, and other relationships.

Source: Adapted from Halliday & Hasan (1976).

We went to the circus, and I saw elephants. John’s angry because I drank his soda.

Chapter 6

Analysis Across Utterances and Partners and by Communication Event


based on the speaker principle, in which the referential point shifts as speakers change, and on the distance principle, in which referents are coded by their distance from the speaker. Words with deictic meanings appear in several word classes, including personal pronouns (I/me and you), demonstrative adjectives (this, that, these, and those), adverbs of time (before, after, now, and then), adverbs of location (here and there), and verbs (come and go). A child’s behavior, especially the errors, should be analyzed to determine confusion or overreliance on one principle or one aspect of a principle. Definite and Indefinite Reference A mature language user is able to mark specific (definite) and nonspecific (indefinite) referents by manipulation of definite (the) and indefinite (a/an) articles. The speaker must consider what the listener knows about the topic under discussion. Article use can be especially difficult for a child with LI. In part, this difficulty may reflect the use of articles in English to mark new and old information also. The tendency for children with LI is to overuse the definite article the. Each article present in the sample can be analyzed for appropriate referential use. Note that Asian American LEP speakers may omit articles reflecting nonuse in many Asian languages. COH ESIVE DEVICES Conversational cohesion, how language hangs together, can be a useful analysis tool. Cohesion can be expressed through syntax and vocabulary. For example, a pronoun or a demonstrative, such as this or that, can refer to the referent, which was identified previously in the conversation. Conjoining, the connection of phrases, clauses, and sentences through the use of such conjunctions as and, because, and if, also is used for cohesion. The major cohesive devices used in English are listed in Table 6.3. The most frequent problems of cohesion relate to providing redundant information, deleting necessary information, using unclear and ambiguous reference, sequencing old and new information, and marking old and new information with articles and pronouns. In short, errors usually reflect including or excluding too much information or confusing new and old information. Reference Reference is a linguistic device used continuously in conversation to keep information flowing and to designate new and old information. In the process, new information is stated clearly and then subsequently implied by the referral to it as old information, one utterance presupposing the other. I’ll explain all this in the following section. Some children with language impairments, such as children with ASD, have difficulty marking new and old information (McCaleb & Prizant, 1985). An SLP must note the method of introducing new information and the use of following mention. Speakers should ensure that listeners can easily determine noun-pronoun relationships. This investigation requires looking beyond traditional utterance-level analysis. Initial Mention In initial mention, mature speakers establish mutual reference clearly, especially if the entity mentioned is not present. Generally, the referent name is stressed and preceded by the indefinite article (a/an). In English, the referent often is placed at the end of the sentence, the most salient position. The following are examples of the introduction of new information: Did you see John at the party? We went to a circus yesterday.


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Communication Assessment

In addition, referents that are present may be pointed to or handled. Young children tend to rely more on these nonlinguistic behaviors to establish new referents. Children with LD or ASD have difficulty with new information (McCaleb & Prizant, 1985; Rees & Wollner, 1981). As speakers, they may not identify new information for the listener, assuming that the listener “just knows” what they’re is thinking. As listeners, these children may have difficulty identifying the new information but will ask few questions to clarify. “These children often do not know what they do not know” and thus cannot inquire about it (Stark, 1985). With increasing language skills, the child is able to be more specific linguistically. Children with word-finding difficulties or poor vocabularies may use empty words, such as that, one, or thing, that do not help clarify the referent. These children may rely on the immediate context and use pointing to specify the referent that their nonspecific vocabulary failed to identify. Following Mention In following mention, previously identified referents often are moved to the initial position in English sentences and may be referred to by the use of the definite article (the) or a pronoun. “Did you see John at the party?” might be followed by “He was so thrilled.” This referral to previously cited information is called anaphoric reference. Pronoun use is appropriate when the referent is unambiguous or clearly identified. The pronoun should be in close proximity so that there is no confusion as to which noun it refers. An SLP is interested in the way a child introduces new information and refers to that information later. Also of interest is any confusion with article and pronoun use. Pronouns and a method of recording a child’s use are included in Table 7.14. It is not uncommon for a preschool child or a child with LD to introduce new information with “She did it,” leaving the listener to determine who she is and what it is. Ellipsis Ellipsis is a process in which redundant information is omitted. For example, the response to “What do you want?” is “Cookie,” which omits the shared information “I want.” Elliptical fragments are used frequently to keep the conversation moving smoothly and rapidly, but they are missed if linguistic analysis concentrates solely on full sentences or fails to look across partners. Children with LI may not realize that information is shared or may assume that it is shared when it is not. Either assumption interferes with the flow of conversation. For example, the child might repeat, “Cookies, Cookies, cookies,” until someone asks, “What about cookies?” to which the child responds in surprise,“I want some,” having assumed previously that the I want was shared when in fact there was no “what do you want?” asked. Conjunction Conjunctions, such as and, then, so, and therefore, are used to connect thoughts. Although preschool children have several conjunction-type words in their vocabularies, they rarely use them to join clauses. Even kindergarten children will overrely on and, which becomes an all-purpose conjunction. In addition, and often is used to mean and then when giving a sequence of events. A developmental progression for conjunctions is given in Table 7.16. Just as conjunctions can be analyzed at the utterance level because of their use in linking clauses, conjunctions can be analyzed across utterances, as in the following exchange.

Chapter 6

Analysis Across Utterances and Partners and by Communication Event


Parent: We had a great day at the zoo. I liked the monkeys best. Child: And feeding the deer babies. Analysis at the level of the child’s utterance alone would miss the child’s considerable skill. Adverbial Conjuncts and Disjuncts Adverbial conjuncts and disjuncts are conversational devices used for cohesion. Conjuncts are intersentential forms that express a logical relationship, such as the conjunctions then or so. Conjuncts are of two types: concordant, such as similarly, consequently, and moreover, and discordant, such as nevertheless, rather, and in contrast. Disjuncts are used to comment on or to convey the speaker’s attitude toward the topic and include words and phrases such as honestly, frankly, perhaps, however, yet, to my surprise, it’s obvious to me that, and the like. Conjuncts and disjuncts develop rather late in childhood and, therefore, may be good measures of adolescent language. Growth is “slow and protracted” (Nippold, Schwarz, & Undlin, 1992, p. 108). By age 12, children use only an average of 4 conjuncts per 100 utterances (Scott, 1988a). In contrast, adults average 12 conjuncts per 100 utterances. Children between ages 6 and 12 use conjuncts infrequently and rely most frequently on then, so, and though (Scott, 1984a). Adolescents use the same conjuncts but also use therefore, however, rather, and consequently most accurately in both their reading and writing (Nippold, Schwarz, & Undlin, 1992). Comprehension seems to be better than production although similar (Nippold, Schwarz, & Undlin, 1992; Scott & Rush, 1985). The conjunct then can be used to signal both continuity and discontinuity in adolescent and adult language (Segal, Duchan, & Scott, 1991). Initially, children use then to mean next, joining clausal information. Later, then is used to focus on ideas presented previously, in contrast to now, which signals that new ideas will be presented on some topic. In addition, then can signal discordance, as in “Then again, I believe . . .” In mature narratives, then is used approximately 20 percent of the time to mark discontinuity by indicating a shift (Duchan & Waltzman, 1992). This shift might be to (1) a different discourse type, as in conversation to narration or the reverse, (2) a new scene or location, (3) a different character in a narrative, or (4) a new perspective. Use of then seems dependent on the use of other conjuncts, such as anyway, meanwhile, whatever, and now. Narratives, discussed in Chapter 8, offer insight into conjunct use. Contrastive Stress Contrastive stress or emphasis can be used to negate or correct the message of a conversational partner. For example, if one speaker said,“Jose brought the cookies,” the other might correct,“Mary brought the cookies.” Again, an SLP must transcend the traditional utterance-level analysis.

Communication Event The term communication event can represent an entire conversation or a portion thereof that includes one topic. For purposes of our discussion, we use the larger definition and include within it a conversation that comprises one or more topics.


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Usually, a shared or negotiated agenda(s) occurs within a conversation. Utterances within the event support this agenda. The teenager who wants to be granted a privilege, such as getting to use the family car, is polite, and each utterance supports this agenda. Conversations may be very difficult for some children unfamiliar with the process or unable to decipher the code. A child may be unclear about the purpose of conversation and his or her role in it. Much of this difficulty can be alleviated by using familiar conversational partners and situations and by following a child’s lead. Younger children and those with LI may need events with more definite beginnings and ends, such as putting together a puzzle. The social organization of discourse consists of the two roles of speaker and listener. The effective communicator has the ability to function in and contribute to the conversation by assuming responsibility for both roles. Assessment variables that might measure a child’s ability to participate effectively are the amount of socialized speech and a child’s adaptive style; conversation and topic initiation, maintenance, and termination; the completeness, relevance, and clarity of a child’s behavior; on-topic exchanges and turn taking; and conversational repairs (James, 1989; Lund & Duchan, 1993; Prutting, 1983; F. Roth & Spekman, 1984a). Analysis occurs at two levels: the molar and the molecular (Prutting, 1983). At the molar level, an SLP evaluates each behavior for appropriateness or inappropriateness within the conversational context. Inappropriate behaviors may indicate problem areas for further assessment. At the molecular level, an SLP is interested in the frequency, latency, duration, density, and sequence of the child’s behaviors. Frequency data will reveal inordinately high- or low-frequency features and information on the range of features. Latency, the span of time when an individual does not engage in behavior, is also important. Pauses and hesitations may reveal difficulty decoding the preceding utterance or forming a response. Duration is the length of time that a child and a partner are engaged in a certain behavior, such as conversational gaze or conversational turns by both partners. Density is the number of behaviors within a certain period of time. Of interest are the density of different conversational topics or specific linguistic structures, such as questions. Sequence includes the order of events within a topic or conversation. A child exhibiting difficulty with sequencing of a conversation may not understand the rules of conversational participation. Decisions of appropriateness may be facilitated through the use of a modified ethnographic technique similar to that used in anthropological studies. Using an expository form of writing, an SLP attempts to describe each child utterance with reference to form, content, and use, discourse relations, code switching, learning and cognitive style, and the partner’s arrangement and selection of nonlinguistic strategies, materials, and procedures (Constable, 1992). Thus, each utterance is given a reference frame in which to judge appropriateness. Table 6.4 provides a sample of a dialogue and the accompanying ethnographic analysis. Ethnographic techniques are especially important when assessing children with CLD backgrounds (Roseberry-McKibbin, 1994). SOCIAL VE R SUS NONSOCIAL Social speech is speech addressed explicitly to and adapted for a listener. It is characterized by explicitness and clarity, repairs of breakdowns, and an obligation for a listener to respond. Social communication includes dialogues and social monologues addressed to a listener or uttered for the mutual enjoyment of both the speaker and listener, such as rhyming and poetic nonsense. The speaker adapts the explicitness of the message for the listener and repairs breakdowns. The speaker’s message is delivered as if the speaker expects a listener response.

Chapter 6


Analysis Across Utterances and Partners and by Communication Event


An Example of Ethnographic Analysis

Language Sample

Ethnographic Analysis

Child: What’s that?

Child does not seem to know the identity of an object and inquires as to its name with an appropriate wh- question addressed to the partner. The partner supplies an appropriate answer but does not elaborate. The child seeks such elaboration by asking a second wh- question in which he omits the auxiliary verb. Other sentence elements are included in the proper adult word order. The partner does not answer the question but responds with a second whquestion in order to have the child guess at the function from its appearance. The child responds inappropriately to the partner’s question, either ignoring the content of the question or miscomprehending the meaning of the wh- word. The partner does not pursue the question by restating or reformulating it. Instead, the partner confirms the child’s utterance and asks a third whquestion incorporating the child’s utterance. Again, the child does not respond to the content of the partner’s question but repeats the previous utterance with no additional information to aid the partner’s understanding.

Partner: That’s a “Thing-a-majibit.” Child: What it do?

Partner: What do you think it does? Child: On the table.

Partner: YES, on the table. What about “On the table?” Child: On the table.

In contrast, nonsocial speech is not addressed explicitly to a listener, and the listener has no obligation to respond. Nonsocial communication is usually for the speaker’s own enjoyment and often consists of asocial monologues. An important measure of communication is the percentage of the child’s utterances or the amount of total talk time that can be characterized as social (F. Roth & Spekman, 1984a). Although preschoolers produce many asocial monologues accompanying their play, the amount of time spent in this type of production decreases with age. School-age children developing typically produce very little nonsocial speech. In general, children’s communication becomes more interpersonal as they mature, with girls more likely to use language cooperatively (D. Cooper & Anderson-Inman, 1988). Boys are more likely to show domination and control, to interrupt and insult, and to play practical jokes. Older adolescents are more concerned for the wants and feelings of others, compromise and reach mutual agreement more, and are more concerned for long-term consequences in their communication than are younger adolescents or children (Selman, Beardslee, Schultz, Krupa, & Podorefsky, 1986). CONVE R SATIONAL I N ITIATION The most efficient way to initiate a conversation is to gain your listener’s attention, greet the listener, and clearly state the topic of conversation or some opener, such as, “Guess what happened to me yesterday?” or “Where have you been? I haven’t seen you in ages.” Openers set the tone of the conversation and the subsequent turns. Opening and closing a conversation is one of the pragmatic problems most frequently encountered in children with LI (A. Johnson et al., 1984). Children with ASD initiate very little conversational behavior—even less than do other children with LI (Loveland, Landry, Hughes,


Part 2

Communication Assessment

Hall, & McEvoy, 1988). Of clinical interest is how a child initiates the conversation and how successful he or she is in having the conversation continue (F. Roth & Spekman, 1984a). Method It is best to get a potential listener’s attention before initiating a conversation. This usually is accomplished by eye contact and a greeting. A child with LI may begin without any greeting or may interrupt an ongoing conversation with, “Hey.” While in a classroom recently, I become aware that a preschooler was talking to my butt. He had neither sought my attention nor offered a greeting. Some children use the same opener repeatedly (e.g.,“Guess what?”), whatever the conversational context. Data may need to be collected over a wide variety of situations to discern a pattern. Role-play or play with puppets or dolls can be used to determine a child’s knowledge of conventional openers. Frequency and Success Rate Children who are withdrawn or unsure of the conversational expectations may initiate conversations only rarely. Instead, they adopt a more passive, responsive role. In contrast, other children may interrupt frequently and attempt to initiate conversation indiscriminately. Of interest to an SLP is the density of initiations, or the number of initiations over a given time. Obviously, this figure will change with the situation. For children, lunchtime, recess, and group projects may be appropriate forums in which to collect such data. The success rate of children in initiating conversations is also significant. Although children may attempt to begin conversations frequently, they may be ignored or mocked, depending on the audiences they choose. Each of us has experienced the “cold shoulder” at least once. Children who are socially inappropriate may experience more than their share. An SLP should note the manner of initiation. TOPIC I N ITIATION Once a conversation has been initiated, the participants negotiate the topics that will be discussed. Topic can be defined as “the proposition or set of propositions or subject matter about which the speaker is either providing or requesting new information” (Bedrosian, 1988, p. 270). This negotiation process begins with one partner introducing a topic; the other partner agrees to adopt that topic by commenting on it, disagrees by changing the topic, or ends the conversation. Mature speakers identify the topic clearly by name and, if in the immediate context, by pointing. Preschool children and those with LI rely more on nonlinguistic cues, such as pointing to and holding or shaking objects. In general, children with LI are less adept than both their age-matched and language-age-matched peers in their ability to direct the conversation by introducing topics (Donahue, 1983). This lack of ability might reflect difficulty introducing topics clearly and/or these children’s limited lists of potential topics (Bedrosian, 1985; Dollaghan & Miller, 1986). Method An effectively initiated topic is identified clearly in order to establish mutual regard. As mentioned, a speaker may point, look at, and/or state the topic. Generally, the speaker provides information the listener needs to identify referents and their relationships. Topics are negotiated between speakers, and even when explicitly stated, topics are based on the shared assumptions of each participant.

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Analysis Across Utterances and Partners and by Communication Event


In general, the less sure a speaker is that a listener knows the topic, the longer the speaker will take to introduce it. A more mature speaker is adept at presupposing the prior knowledge of the listeners. In return for the introduction, listeners assure speakers that they understand, or they ask for clarification when they do not understand. Topics typically are changed by stating a new one. Older elementary school children, adolescents, and adults increasingly use a conversational technique called shading, in which the conversation is steered from one topic to a closely related one. Adult conversations only occasionally contain very disparate topics. Although we don’t possess much normative data, we know that between seventh and twelfth grade the number of abrupt topic shifts in an adolescent conversation decreases from 3.19 to 1.44 (Larson & McKinley, 1998). A child with LI may not establish topics, preferring to adopt those of others. If a child does introduce topics, there may be little or no background information to aid the listener (Brinton & Fujiki, 1992). A child with LI may have a very restricted set of conversational or topic openers or may rely on a stereotypic utterance (e.g., “Guess what?”). Children with emotional difficulties may continue some internal conversation with the assumption that the listener has been privy to this information. As mentioned previously, children with word-finding difficulties or poor vocabularies may rely on nonspecific nouns, such as one or thing. Nonspecific verbs, such as do and get, also may be used frequently. “I did that one” may not get the topic off to a roaring start. A child’s responses to the openers of others may be nonexistent or noncontingent/off-topic. The child may not be able to identify the topic or to determine what response is required to the partner’s opener. Both the linguistic and nonlinguistic aspects of a sample should be analyzed. The nonlinguistic aspects, such as eye contact, regulate the linguistic ones and are significant in the regulation of turn initiation and termination, topic choice, and interruptions (Prutting, 1982). Frequency and Success Rate As with conversational initiation, the density and success rate of topic initiation are noteworthy. In general, less dominant speakers will introduce fewer topics and will be less successful in having their topics adopted by their partners. Lack of success also may indicate problems with topicalization, such as establishing and commenting on, marking changes in, and maintaining the topic for a sufficient length of time (A. Johnson et al., 1984). Related factors to be evaluated are the articulation clarity, degree of completeness, and form of the topic statement; social adaptation of a child’s language style; degree of content relevance to the ongoing activity and to listener interests; use of eye contact; and physical proximity (F. Roth & Spekman, 1984a). Appropriateness The appropriateness of a topic is determined by the context. Some topics, such as the weather, are always appropriate, whereas others, such as age, income, or sexual behavior, are appropriate only in limited contexts. Each of us has favorite topics. An SLP is interested in determining a child’s favorite topics and in assessing their appropriateness in context. Although some topics will work in one context, they are inappropriate for others. Some children with LI have only limited topics or perseverate on a few regardless of the context. I worked with two brothers with ASD who seemingly could talk only about mathematics. A third child with severe LD seemed limited to discussing throwing up, a topic with not much appeal.


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Communication Assessment

CONVE R SATION AN D TOPIC MAI NTE NANCE Once a topic is introduced, speakers comment, each sentence reflecting the general discourse topic. In effective conversations, the participants seem to adhere to four principles: stay on topic, be truthful, be brief, and be relevant (F. Roth & Spekman, 1984a). Each partner depends on a response’s contingency, or relatedness to the preceding utterance. Each response adds new information on the topic. The topic is mentioned frequently enough to enable both participants to recall it as the conversation progresses, because the topic becomes less specific with each subsequent reference. Topic continuance may be signaled by maintenance devices, such as now, well, and then, in any case, next, so, followed by I (you, we, they) (did something). Some devices, called continuants, maintain the conversation but add little if any new information. Examples of this behavior are yeah, uh-huh, and okay when used as a signal that the listener is paying attention. Other maintenance devices are repeating a portion or all of the previous utterance. Children with LI tend to engage in fewer and shorter interactions than do children developing typically. The most frequent pragmatic problems for children with LI include connecting discourse cohesively, listening and responding to a speaker, knowing when to take a turn, and knowing how to ask and answer questions (A. Johnson et al., 1984). Although there is little difference between the turn-taking skills at the one-word level of children with LI and of those without, a disparity occurs and widens as language becomes increasingly more complex (Foster, 1985; Prelock, Messick, Schwartz, & Terrell, 1981; Reichle, Busch, & Doyle, 1986). Children with ASD may not respond to initiations, while other children with LI may overuse turn-fillers or acknowledgments (uh-huh) to keep the conversation going even when their comprehension is lacking. (Bedrosian, 1988; Brinton & Fujiki, 1989). Frequency of Contingency Semantically contingent utterances relate to or reflect the meaning of the prior utterance. Thus, a contingent utterance maintains the topic of the previous utterance and adds to it in some way. For example, in response to the utterance, “We went to Captain Jake’s for dinner last night,” a second speaker might make the contingent remark “Oh, did you enjoy the food?” A noncontingent remark would be “My uncle lives on a farm.” Assume for a moment that the name of the restaurant in the previous example was Uncle Jake’s. In this situation, the child’s remark,“My uncle lives on a farm,” although off-topic, does have some link to the previous sentence. If these links can be identified, there may be a pattern that will reveal the child’s processing strategy. In general, children with LI are less responsive than are their age-matched TD peers (RosinskiMcClendon & Newhoff, 1987). This low level of responsiveness may reflect a history of unsuccessful communication. Often, these children respond to questions with stereotypic acknowledgments (uh-huh, yeh) and with nonspecific requests for clarification (what, huh) (Rosinski-McClendon & Newhoff, 1987). The frequency of contingent behaviors by a child and caregiver also is of interest. The child who exhibits few contingent utterances may prefer to initiate new topics instead. The SLP notes the percentage of a child’s utterances that are on-topic, the relevance of the child’s questions, and the child’s nonverbal responses, such as following directions or looking at something that was mentioned. A large percentage of off-topic responses may indicate a semantic disorder characterized by difficulty in identifying the topic of discussion. A listener’s ability to identify a topic subsequently affects

Chapter 6

Analysis Across Utterances and Partners and by Communication Event


comprehension of comments made about that topic. Imagine responding to “what do you think?” When you can’t identify what’s being discussed. The SLP should look for an underlying contingency that may not be readily obvious. Children with LD may assume that their partners know the underlying relationship and, therefore, may only include unshared information. Of particular interest are the child’s responses to questions. Such responses should be appropriate to the question and factually correct. For example, the question “Why is he eating?” might elicit the following responses from different children: 1. 2. 3. 4. 5.

Food. Because. He has to. So he won’t be hungry. He’s hungry.

The first answer is inappropriate although functionally accurate. It does not answer the question, but tells what the man is eating. The second and third responses are appropriate but too brief to be accurate. The fourth and fifth answers fulfill appropriateness and accuracy criteria. If an answer does not fulfill both appropriateness and accuracy requirements, it is in error and may indicate any number of possible breakdowns in the communication process. I have worked with a child with severe emotional disorder who gave extremely inappropriate replies to emotional or personal questions, although her responses to factual questions were usually both appropriate and accurate. A child with LI may not understand what the questioner desires or may not realize that a reply is required. The question form and the specific wh- question type also may be confusing. In general, recognition and delivery of the general kind of information required develops prior to the ability to respond with the accurate information. Some wh- question forms seem easier than others. Three groupings, from easiest to most difficult, are as follows: Easiest Most difficult

What + be, which, where Who, whose, what + do When, why, what happened, how

This order suggests a hierarchy for both analysis and intervention. In addition, it is easier for children to respond to questions referring to objects, persons, or events within the immediate setting. Various semantic question prompts can be used to facilitate production of a child’s inadequate responses. A child’s responses to these prompts can provide useful information for intervention, such as knowing which prompts aid responding. Table 6.5 presents a procedure for comparing the efficacy of various prompts in eliciting appropriate and accurate responses from a child. A plus sign (+) indicates appropriate or accurate responses; a minus sign (–) indicates inappropriate or inaccurate ones. Latency of Contingency When a child makes a contingent response, there should be little delay or latency between his or her turn and the preceding speaker’s turn. Gaps between the turns of mature speakers are brief or nonexistent. Research has indicated that the average amount of time needed for two adults to switch from


Part 2


Communication Assessment

Score Form for the Efficacy of Various Question Prompts Prompt Effectiveness (+, –)

Prompt Type

Strategy Description

Standard focusing phrase with repetition

Listen to the question signals the student that a response was in error. Direct student’s attention to the repetition; highlight content.

Model example with related content

Use another adult or child in context to model correct response. Then ask child, same form, new content.

Analogous examples

What are alligators covered with? —No response. Seals are covered with fur. What are alligators covered with?

Visualization of relationships

How are an apple and a cook alike? No response. Draw semantic feature chart: grows bakes eat on tree

Relevant comparison yes/no











What does a hockey player need? No response. Does a hockey player need skates? Yes. Good. What does he need?

Note: The child’s inadequate responses can be modified by using question prompts. Successful responses following a prompt are recorded as a + under both the appropriate and accurate columns. Source: Moeller, M., Osberger, M., & Eccarius, M. (1986). Cognitively based strategies for use with hearing-impaired students with comprehension deficits. Topics in Language Disorders, 6 (4), 37–50. Reprinted with permission.

one speaker to the next is half a second or less. Although there are no norms for children, this value is an important description measure. Preschoolers and children with LI may allow long gaps to develop without any of the apparent embarrassment found among adults when there are long unfilled pauses. A noticeable latency prior to a child’s response may indicate word-finding difficulties or lack of comprehension. Frequently, the linguistically more mature partner will fill in for the child, an act that violates the rules of turn taking. Latency is an important measure for both contingent and noncontingent utterances, whether adjacent or nonadjacent. Adjacent utterances are spoken as sequential behaviors by the same speaker. A nonadjacent utterance crosses conversational turns and is an utterance or turn of one partner followed by an utterance or turn of the other. Definitions and examples of these categories are presented in Table 6.6.

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Analysis Across Utterances and Partners and by Communication Event


Definitions and Examples of Utterance Pairs





The utterance of one speaker is based on the content, form, and/or intent of the other speaker.

S1: What do you want for lunch? S2: Peanut butter. S1: I hope I don’t miss my plane. S2: Don’t worry. Every flight is delayed.


The utterance of one speaker is not based on that of the other.

S1: What do you want for lunch? S2: Gran’ma gots a new car.


Utterances spoken sequentially by the same speaker.

We went to the zoo. I saw monkeys and elephants. But my favorite part was petting the sheeps.


Utterances spoken sequentially by different speakers. The utterances may be contingent or noncontingent.

S1: Here comes the school bus. S2: Yukk, I was hoping he’d get a flat tire. (Contingent)

DU RATION OF TOPIC A topic is sustained as long as each conversational partner cares to continue and can contribute relevant information. The number of turns taken on a topic is a function of the particular topic and partners involved, the conversational context, and the conversational skill of each participant. Number of Turns on a Topic The SLP is interested in the number of turns taken by a child and a partner on a given topic and in the manner of changing topic. In general, a greater number of turns will occur in an adult-child conversation if the child, rather than the adult, initiates the topic. Topics that are sustained longer than others may suggest the child’s interest or knowledge or both. Below age 3, children rarely maintain a topic for more than two turns. In general, preschoolers take very few turns on a single topic unless enacting scenarios, describing events, or solving problems (Schober-Peterson & Johnson, 1989). More turns generally will be produced when the preschool child is directing the partner through a task or when the child is telling a story. Although the number of turns increases slightly with age, a great increase does not occur until mid-elementary school. Informativeness Each turn should add to the conversation by confirming the topic and contributing additional information. Children who have difficulty identifying the topic or determining what is expected of them conversationally may repeat or paraphrase old information, overuse continuants, or circumlocute. Circumlocution occurs when a child is unable to identify the topic or retrieve needed words and thus talks around the topic in a nonspecific manner. The SLP can rate each utterance for its contribution to the topic being discussed.


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Communication Assessment

Sequencing Once a topic is introduced, a sequence of conversational acts follows. In general, more specific information is introduced until a natural termination or a change in topic occurs. Answers or replies follow questions; comments or questions follow comments. New information is introduced and later referred to as old information. A lack of sequencing may indicate a semantic disorder or a pragmatic disorder characterized by a lack of presuppositional abilities. Further analysis of conversational turns is discussed later in the chapter. TOPIC ANALYSIS FOR MAT Several topic analysis formats have been proposed (Bedrosian, 1982, 1988, 1993; Mentis & Prutting, 1991). Each addresses different aspects of topic initiation, maintenance, and change. These are presented in Table 6.7. Topic initiation analysis may include the type of topic, the manner of initiation, the subject matter and orientation, and the outcome. Topic maintenance analysis may consider the type of turn and the ability of the client to further the conversation with the addition of new conversational information. Topic Initiation Topic initiations occur when the topic of discussion is changed in some way. Utterances on that topic express concepts subsumed by that topic. Each new topic and directly related utterances can be identified on the transcript. Type of Topic Each topic could be rated according to its novelness. Some children have a limited range of topics in their repertoire. Possible rating categories may include new, related, reintroduced, and consecutive (Bedrosian, 1982, 1988, 1993; Mentis & Prutting, 1991). New topics would be those appearing in the conversation for the first time and not linked to the immediate preceding topic. Related topics would be linked directly to the previous topic. Reintroduced topics would have appeared in the conversation previously but prior to the immediate preceding turn. Finally, consecutive topics consist of two or more topics initiated in a turn with no opportunity for the listener to maintain the preceding topic or the first of the consecutive ones to be introduced. In addition, the SLP could check with the caregivers to determine whether any of the topics introduced by the child are habitual ones. Table 6.8 presents examples of different types of topic initiation. Manner of Initiation The manner of topic initiation might include coherent changing, noncoherent changing, shifting, and shading (Bedrosian, 1982, 1988, 1993; Mentis & Prutting, 1991). Coherent changTABLE 6.7

Analysis Aspects of Topic

Topic Initiation

Topic Maintenance

Type of topic

Type of turn

Manner of initiation

Conversational information

Subject matter and orientation Outcome

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Analysis Across Utterances and Partners and by Communication Event


Types of Topics Initiated

Topic Type



Partner: Uh-huh, and what else did you see at the zoo? Child: Mommy got a new car.


Partner: I like monkeys too. What else? Were there any clowns at the circus? Child: I don’t like clowns. They’re scary. Partner: Clowns are scary? Why do you think clowns are scary?


Child: And Ernie spilled s’ghetti all over Bert. Partner: Was Bert angry? Child: Uh-huh. And . . . and Ernie . . . And Ernie laughed. Partner: Poor Bert. That would be yukky. What else happened on Sesame Street? Child: Big Bird and Little Bird singed a song. Partner: Can you sing it for me? Child: Uh-huh. I don’t like s’ghetti on me.


Partner: Oh, tell me the story. Child: Okay. This little girl . . . Can you come to my birthday party? I got a new bike yesterday. Do you live here?

ing occurs when one topic is terminated and a following topic’s content is not derived from the immediate preceding topic. Noncoherent changing occurs with the absence of topic termination and/or an utterance signaling transition to a new topic. Shifting occurs when the topic being discussed serves as a source for a new topic. Shading differs from shifting in that shading is a change of focus on the same topic, rather than a discrete topic change. Table 6.9 presents the different manners of initiation. Subject Matter and Orientation The subject matter is the content of the topic initiation. Two broad analyses might consist of judgments of appropriate versus inappropriate topics for the communication context. Orientation might include topics about self, a shared experience or interest with the listener, or a topic seemingly unrelated to the listener or a shared interest. If the topic is always the speaker or always unrelated, then serious communication problems may exist. Outcome Outcomes may be rated as successful or unsuccessful (Calculator & Dollaghan, 1982). Success is dependent on the manner of initiation, the subject matter, and the form of the initiation. A command or demand is probably not a good initiation for encouraging conversational interaction. Success occurs when the conversational partner acknowledges the speaker’s topic in some way, responds, repeats, agrees or disagrees, or adds information to maintain the topic. Nonsuccess includes no response, an interruption, initiation of a new topic, or a request for repair. Although there are many variables related to success, the percentage of time that a child is successful can be an important descriptive index. Topic Maintenance Topic maintenance would be analyzed in all turns subsequent to topic initiation. Each turn can be analyzed on the basis of the continuous or discontinuous nature of the turn and on its informativeness.


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Communication Assessment

Manner of Topic Initiation

Manner of Initiation


Coherent changing

Child: And he chased the dinosaur away. Partner: What a great story. Anything else to tell? Child: I have a new baby.

Noncoherent changing

Child: Let’s have toast for breakfast. Partner: Let me fix it. Child: Those are supposed to go down. Partner: You do this one, and I’ll do the other one. Child: I’m gonna have a bowl of . . . What’s that? I think it’s a fireman hat. I wanta be a fireman. Partner: May I wear it?


Partner: There, I’m gonna make some eggs. Child: I don’t like eggs. Partner: No, why don’t you like eggs? Child: I want some . . . some juice. I like juice. Partner: What kind of juice do you want?


Partner: Let’s have toast. Child: Where’s the toaster? Partner: I’ll cook the toast. Child: I’ll butter it. Where’s the knife? Partner: You have to find the knife. Child: It too sharp for toast.

Type of Turn. Turns may be classified as continuous or discontinuous on the basis of their linkage or nonlinkage to the topic (see Table 6.10) (Bedrosian, 1985, 1993). Continuous turns include responses to requests or questions; acknowledgments, such as uh-huh, okay, and yeah; partial, whole, or expanded repetitions; appropriate emotional responses, including laughter and crying; topic incorporation, such as the addition of more information or a request for more; shading; agreement or disagreement; and a request for repair (Bedrosian, 1985). Discontinuous turns—ones not linked to the current topic—include new topic initiations, off-topic responses, monologues, and evasion, including inappropriate use of silence. Analysis includes the frequency and range of each type of turn and the average number of turns per topic. The percentage of continuous versus discontinuous turns also would be valuable data as a descriptive value although no norms exist. (Bedrosian, 1993). Conversational Information. Turns might be analyzed for the extent to which they contribute to the development of the topic by adding relevant, novel information (Mentis & Prutting, 1991). Those adding new information include topic incorporation, such as unsolicited conversational replies that add more information or requests for new information, and answers and replies to questions that contain new information. Other turns—such as acknowledgments; requests for repair; partial, whole, or expanded repetitions; responses to requests or questions that do not contain new information; emotional responses; and agreement or disagreement—add no new information to the conversational

Chapter 6

TABLE 6.10

Analysis Across Utterances and Partners and by Communication Event


Continuous and Discontinuous Turns

Type of Turn



Partner: What’s that? Child: A cowboy hat. Partner: Put it on. Child: No, it’s too hot for a coat. Partner: We have to make some bread for dinner. Child: Okay, I’ll help.


Partner: Do you want to hold the baby? Child: I’ll eat my cupcake now. Partner: What else happened at school? Child: I don’t like my baby brother.

exchange. Problematic turns include word searching, incoherent utterances, ambiguous utterances, and incomplete turns. Examples of conversational information rating are included in Table 6.11. The SLP can calculate the percentage of turns contributing novel information and thus furthering the topic. Other types of turns may indicate possible problem areas. Specific strategies used by children should be investigated by analyzing the form of the utterances being used. Summary The topic analysis categories presented in this section overlap and are not always mutually exclusive. More than one turn type and informativeness category may be present in a turn. A possible analysis format is presented in Table 6.12. Each type of analysis gives an SLP an additional tool for sorting the child’s language data. TABLE 6.11

Informativeness of Turns



New information

Partner: Where’s Mary? Child: She’s sick today. Partner: We’re going to the zoo tomorrow. Child: Monkeys live in the zoo.

No new information

Partner: And cowboys ride horsies too. Child: Ride horsie. Partner: Let’s play with the stove. Child: What? Partner: What should we play now? Child: A . . . a . . . with a . . . a . . . with a . . . you know. Partner: Who’s your teacher? Child: At school.



Part 2

TABLE 6.12

Communication Assessment

Possible Format for Rating Topics and Turns Turns


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Total

% of Total

Topic Initiation Type of topic New Related Reintroduced Consecutive Manner of initiation Coherent change Noncoherent change Shifting Shading Subject matter Appropriate Inappropriate Orientation Self Shared Unrelated Outcome Successful Unsuccesful Topic Maintenance Type of turn Continuous Discontinuous Conversational information New information No new information Problematic

TU R N TAKI NG Turn taking is an excellent vehicle for evaluating the interactional framework of a listener and a speaker. The unit of analysis is the dyad (both partners) and the interaction, rather than the individual behaviors of the child (Prutting, 1982). The rules of turn taking specify that if only two participants are involved, both have speaking turns. In general, TD children’s conversations consist primarily of this nonsimultaneous talking pat-

Chapter 6

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tern (Craig & Washington, 1986). If more than two are involved, however, no participant is guaranteed a speaking turn. There is usually only one speaker at a time. If two or more speak simultaneously, all but one withdraw. Children with emotional disabilities may interrupt the speaker before the turn has ended, may ask and answer their own questions, and may take another speaker’s turn (Rees & Wollner, 1981). The listener pays attention to the speaker and demonstrates this behavior by turning toward or looking at the speaker, not interrupting, and/or acknowledging that he or she has heard and understood the speaker. In contrast, eye contact among children with LD and emotional disturbances is often fleeting or nonexistent. The minimum number of turns to complete an exchange is three. The person who begins the exchange must have a second turn before an interaction has occurred: for example, Speaker 1: We just returned from Florida. Speaker 2: Oh, did you go to Disney World? Speaker 1: No, we were in Fort Lauderdale. Ever been there? Each full conversational turn consists of three elements: an acknowledgment of the preceding utterance, a contribution by the present speaker, and an indication that the turn is to be shifted. In the preceding example, the previous turns are acknowledged by oh and no. Indications of turn allocation may consist of questions, intonational markers, and pauses. Transitions across speakers are orderly, occurring at transition points signaled by the participants. For example, a speaker will look at or address the listener when about to change a turn. The listener may look away, gesture, become restless, or emit an audible sigh when desiring a turn. A really anxious listener may cut off the last few syllables of the speaker’s turn without disrupting the topic. Children with LI often do not use these subtle turn indicators and miss their signal value when used by others (Rees & Wollner, 1981). Finally, the speaker who wishes to continue a turn may increase the speed or intensity of talking and continue through the transition point. If overlap occurs and interferes with understanding, the speaker “repairs” the misunderstood portion. An SLP can mark each exchange on the transcript, numbering it turn 1, 2, 3, etc. In other words, a child’s ability to initiate, add to, and terminate exchanges can be noted. Of particular interest are eye contact, turn allocation signaling, and the location and cause of exchange breakdown. In addition, an SLP can indicate the frequency, variety or range, and consistency of a child’s communication. Within each turn, the SLP notes the presence or absence of the three aspects of a full turn and the average amount of time spent in a turn (F. Roth & Spekman, 1984a). The SLP also can examine the effects of adult behaviors on the child’s conversational turns and later can help adults develop more facilitative styles. Turns may be classified as oblige, comment, or response (Coelho, Liles, & Duffy, 1991). An oblige is initiated by the speaker and demands a response. In contrast, a comment is initiated by the speaker but does not require a response. A response is a reply to either an oblige or a comment. The percentage of each category may indicate active and passive speakers, those that initiate and those that respond. All responses to obliges can be analyzed further as adequate, adequate-plus, inadequate, and ambiguous (Shadden, 1992). Adequate responses give only the information requested; they are appropriate for the request. Adequate-plus responses give more than requested, while inadequate do not give enough. Inadequate responses may be invalid, irrelevant, or insufficient. Ambiguous responses are unclear. Examples are given in Table 6.13.


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Communication Assessment

TABLE 6.13

Types of Turns

Turn Type



Do you want some cookies? What time is it? What’s that?


I really love to ski. I saw horses in the parade.

Response to comment

(Comment: This dessert is great!) It’s an old family recipe.

Response to oblige Adequate Adequate-plus Inadequate Ambiguous

(Oblige: How old are you?) I’m 25. I’m 25, and I have a master’s degree. I go to college. None of your business. Guess.

Density An SLP is interested in the density of turns within each conversation and on various topics. A low density may indicate that a child’s conversational partner dominated the conversation by taking very long turns, relinquishing them to the child only occasionally, or that the child was very reticent. Children with ASD may take relatively few verbal turns, thus leaving the partner to fill the void (Loveland et al., 1988). In contrast, if a child talked for lengthy turns, the density also would be low because the listener would have little chance to reply. Oddly enough, the rate of interrupting increases during the teen years, but the purpose changes. Increasingly, speakers interrupt not to disrupt or change the topic but to move the discussion forward to facilitate communication (Larson & McKinley, 1998). Latency An SLP can summarize the overall contingent and noncontingent latencies of a child. Whereas the average adult-to-adult turn changes within about half a second, a child may be slightly slower to react. Longer periods and/or the continual use of fillers and interjections may indicate difficulties with topic identification or word finding. Duration of Turns There is no ideal length for a turn, although most listeners know when a turn has continued for too long. We all know at least one incessant talker who does not know when enough has been said. A child who talks incessantly may be exhibiting a semantic disorder of not knowing what information is needed to close the topic, a pragmatic disorder of not knowing the mechanisms for closing a topic, or a processing problem of not being certain what information was conveyed. The SLP is interested in the average length of the child’s and the partner’s turns. Different situations, partners, and topics may yield clinically significant differences in the length of these turns.

Chapter 6

Analysis Across Utterances and Partners and by Communication Event


Type of Overlap Most turns will be nonsimultaneous (Craig & Evans, 1989). However, overlap or simultaneous speech can be very revealing. In general, overlap is of two types: internal and initial. Sentence internal overlaps are used to complete the other speaker’s turn and secure a turn. This ability requires a high level of pragmatic-linguistic knowledge. A child with LI may interrupt internally, indicating a lack of understanding of the process. The child may add new information or change the topic, rather than completing the other speaker’s utterance (Craig & Evans, 1989). Sentence initial overlaps result when a listener interjects between sentences to secure a turn. This interjection may occur when the listener is unsure of the speaker’s intention to continue or when the listener wants to gain a turn at speaking. Continual overlaps of this type may indicate a breakdown in turn taking as a result of the behavior of one or both partners. In contrast, a low incidence of interrupting, as noted among some children with SLI, may indicate passivity or an inability to initiate a “turn grab” (Craig & Evans, 1989). Frequency of Overlap Although it may seem counterintuitive, data indicate that, as a group, children with LI exhibit less simultaneous speech in their conversations (Craig & Evans, 1989). Although children with LI may be responsive, many are passive in initiating interaction or turn taking (Fey & Leonard, 1983). Duration of Overlap The adult rules for turn taking state that when an overlap in turns occurs (when two speakers speak at once), one speaker will withdraw. Young children or children with LI may continue to talk or try to outshout their partners. Some children withdraw habitually. The SLP must determine whether the child in question is more likely to withdraw or to continue talking. How Signaled? Changes in turn are signaled very subtly. A child with LI may miss such signals. Occasionally, such a child will respond only to questions, knowing that in this situation a response is required. Other children lack a basic understanding of the expectation to reply within a conversation. Still others cannot decipher the language code efficiently enough to respond. CONVE R SATION AN D TOPIC TE R M I NATION Conversations or topics are ended when no new information is added. In the case of a conversational termination, the topic is not changed. As with the opening of a conversation, there are often adjacency pairs, such as “Bye, see ya”–“Have a nice day” or “Thank you”–“You’re welcome.” Preschool children or those with LI may end the conversation abruptly when they decide it is over, occasionally just exiting the conversational context. Children with LD may not prepare the listener for the termination of the conversation by signaling with body language—for example, becoming restless, looking away, or looking at a watch. In the opposite extreme, children with LD or emotional disorder may be unable or unwilling to end the conversation and may perseverate or continue to ask questions that have been answered previously. Topics usually are terminated by shifting to another related topic. For more mature language users, this process is accomplished by shading, in which the speakers shift to another aspect of the topic or to a closely related topic, as in the following exchange: Speaker 1: I biked along the canal path yesterday. Speaker 2: Oh, I love to bike there at this time of year.


Part 2

Communication Assessment

Speaker 1: I didn’t know you bike. What sort of bike do you have? Speaker 2: I have an inexpensive 12-speed. Speaker 1: I have a 21-speed . . . The original topic of the canal bike path slid into the topic of bicycles. Whether topics are shaded or are changed abruptly, there is normally some continuity, and the new topic is stated clearly. When there is little left to discuss on a given topic, the conversation shifts. The SLP notes the method the child uses to terminate and change topics and to terminate conversations. CONVE R SATIONAL B R EAKDOWN For intervention purposes, an SLP’s analysis of the language of children with LI is an attempt, in part, to find where they are ineffectual, where they fail to communicate. It is important for an SLP to determine where these breakdowns occur and how a child attempts to repair them (Audet & Hummel, 1990). The SLP should try to determine the number of conversational breakdowns and describe the cause of breakdown, the repair attempt, the repair initiator, the repair strategy, and the outcome (F. Roth & Spekman, 1984b). Requests for Repair Requests for repair, called contingent queries, signal the listener’s attentiveness or understanding and skill in addressing the point of conversational breakdown. Conversations may be maintained by use of simple contingent queries, such as Huh?, What?, and I don’t understand. Such requests for repair maintain the conversation by indicating the point of breakdown, obligating the speaker to clarify, and specifying the appropriate form for that clarification. The type of repair request varies with the linguistic maturity of the speaker and with the information sought. In general, young children use unspecific requests, such as Huh? and What? More mature speakers try to specify the information desired, as in the following exchange: Speaker 1: We went to the zoo and saw monkeys in big cages. Speaker 2: What was in the cages? (or Where were the monkeys? Where did you go?) Requests for repair may seek repetition of the preceding utterance, confirmation, or clarification. Appropriate requests for repair and responses by the conversational partner demonstrate an awareness of the cooperative nature of conversation. Not only must a child attend to the partner’s message, detect misunderstandings, and initiate an appropriate request, but he or she also must possess the knowledge and willingness to use clarification strategies to aid the partner’s comprehension (Dollaghan, 1987). A child who continually responds with Huh? or What? may not be attending to the conversation or may have difficulty understanding. In the classroom, such children may rely on routines to make the world understandable. In this case, the child often may look around at the other children for assurance before performing the expected behavior. The SLP is interested in the degree to which a child requests additional information toward maintaining the conversation and in the form of these requests. These conversational mechanisms can be triggered in conversation by the SLP’s garbling or confusing the message. This can be accomplished by mumbling, failing to establish the topic, or providing insufficient information or confusing instructions.

Chapter 6

Analysis Across Utterances and Partners and by Communication Event


A child with LI may be unaware that communication breakdown has occurred. The SLP can hypothesize about the child’s awareness of misunderstanding and confirm the hypothesis through manipulation of utterances addressed to the child. In general, children first gain awareness of breakdowns caused by unintelligible words. The order of awareness to breakdown may be as follows (Dollaghan & Kaston, 1986): Unintelligible word Impossible command Unrealistically long utterance Unfamiliar word Question or statement without an introduction and ambiguous, inexplicit, and open-ended statements Frequency and Form In general, preschool children and those with LI, such as those with LD, tend to blame themselves, rather than the speaker, for misunderstanding (Meline & Brackin, 1987). Thus, these children use fewer requests for repair than might be expected, especially given the greater likelihood of communication breakdown. The requests produced tend to be less specific, reflecting the difficulty encountered with these forms. In short, as listeners, children with LD do not accept the responsibility to signal miscomprehension, even when taught the procedures for doing so. Instead, these children assume that the speaker will be unambiguous, informative, and clear. Children’s repair strategies can be assessed in different contexts, such as familiar topics, unfamiliar topics, and contrived pragmatic violations, by the SLP (Moeller et al., 1986). A child’s attempts to repair can be recorded on a form such as that shown in Table 6.14. Checks in the appropriate spaces would signal the child’s attempts to repair and clarify. Although there are no norms for the frequency of repair requests, general guidelines do indicate a change in both the frequency and type of contingent query with age. The earliest requests for repair are repetitions of the partner’s utterance with rising intonation (Doggie go ride?) or nonspecific requests for repetition (What?). With age, requests become more specific and increase in frequency, although both vary according to the conversational partner. With an adult partner, 24- to 36-month-olds use approximately 7 requests an hour, and 54- to 66-month-olds use approximately 14 (Fey & Leonard, 1984). When the partner is a familiar peer, the mean rate for 36- to 66-month-olds is 30 per hour (Fey & Leonard, 1984). Obviously, there is greater likelihood of misunderstanding when two preschool peers communicate. Conversational Repair Conversational repair may be spontaneous or in response to a request for repair. Preschool children spontaneously repair very little. Even in first grade, children spontaneously repair only about one-third of their conversational breakdowns. Young children or children with LI often do not attempt to repair communication breakdowns. Most 10-year-olds are able to determine communication breakdown and repair the damage. Although children with LD at that age can identify faulty messages, they do not seem to understand when to use these repair techniques. By age 2, most children respond consistently to neutral requests, such as “What?”, although they are more likely to respond if the conversational partner is an adult rather than another child. Two-year-olds also tend to overuse “yes” and thus confirm interpretations


Part 2

TABLE 6.14

Communication Assessment

Record of Requests for Repair

Clarification Skills

Familiar Topic

New Topic

Contrived Pragmatic Violation

Fails to seek clarification Indicates nonunderstanding —nonverbally puzzled expression shrugs shoulders —verbally asks for repetition says/signs What? I don’t understand I don’t remember Indicates inability to answer I don’t remember I don’t know the word for it I don’t explain it Requests specific clarification What did you say about the _____? What does _____ mean? A pattern of clarification requests may evolve as the speech-language pathologist records the number of requests by type and by conversational context of the familiar or new topic or the contrived violation. Contrived errors or violations can be used to elicit requests for clarification. Source: Moeller, M., Osberger, M., & Eccarius, M. (1986). Cognitively based strategies for use with hearing-impaired students with comprehension deficits. Topics in Language Disorders, 6(4), 37–50. Reprinted with permission.

even when incorrect, possibly because nonconfirmation requires clarification on their part. By age 3 to 5, children respond correctly, even to specific requests, about 80 percent of the time regardless of the partner (Anselmi, Tomasello, & Acunzo, 1986). Repair can provide valuable information about communication breakdowns. Breakdown can occur for a number of reasons, including lack of intelligibility, volume, completeness of information, degree of complexity, inappropriateness, irrelevance, and lack of mutual attention, visual regard, or mutual desire. As might be expected, children with LI experience a greater number of breakdowns than do agematched TD peers (Fey, Warr-Leeper, Webber, & Disher, 1988; MacLachlan & Chapman, 1988). Repairs usually focus on the linguistic structure or on the content or nature of the information conveyed. Extralinguistic signals, such as pointing, may be used to clarify. These strategies are not mutually exclusive. In general, successful outcome is related to the explicitness and appropriateness of the repair strategy chosen. When a child repairs spontaneously, the nature of the original error and the repair attempts should be noted. The SLP scans the transcript for all fillers, repetitions, perseverations, and long pauses. All of these may indicate word-finding difficulties on the child’s part. The original error or repair attempt may be based on any number of relationships with the intended word or phrase, as noted in Table 6.15. Spontaneous Versus Listener-Initiated An SLP is interested in the percentage of conversational repairs that are either self- or listener-initiated. Usually, listeners signal a breakdown with facial expression, body posture, and/or a contingent query.

Chapter 6

TABLE 6.15

Analysis Across Utterances and Partners and by Communication Event


Relationship of Word-Finding Errors and Repair Attempts to the Intended Word




the thing you cook food on for stove


the long skinny one with no legs for snake book holder for bookend fuzzy for peach

Generic (less specific)

do for more specific verb hat for cap, bonnet, scarf, etc. thing or one for name of entity


sit for stand


ball . . . big ball . . . red ball for big red ball

Semantic category

stove for refrigerator (both are appliances)


t oe for t ie (initial sound similar) goat for coat (rhyme)

Strategy Immature speakers usually respond to listener-initiated requests for repair by restating the previous utterance. First graders and younger children will repeat only once in response to a request before becoming irritated. By second grade, children usually are willing to repeat twice before becoming angry. Continued requests also may result in children providing additional information, although children with LI seem less flexible in the use of this strategy (Brinton, Fujiki, & Sonnenberg, 1988). More mature speakers usually give additional information or reformulate, rather than repeat the utterance. Using their presuppositional skills, such speakers may hypothesize about the supposed point of breakdown and supply more information on this specific area. When requested to clarify, children with LI tend to respond less frequently and with less complex responses than do their peers developing typically (Brinton & Fujiki, 1982; Brinton et al., 1986). The responses of children with LI lack flexibility and usually consist of repetition with little new information included to aid comprehension. Children developing typically seem to have a greater range of repair strategies at the same age (Brinton et al., 1988). The 10-year-old child with LD is more likely to repeat, rather than reformulate, unsuccessful utterances (Feagans & Short, 1986). An SLP should prepare a list of the various types of requests for clarification and use them in conversation with a child. Of interest is the child’s rate of responding to various requests and the nature of the child’s responses (Fey et al., 1988). Frequency of Success An SLP is interested in how successfully a child identifies breakdowns, repairs them spontaneously, and follows listener requests. In general, children with LI make more inappropriate responses to listener requests than do age-matched TD peers (Brinton et al., 1988). For assessment purposes the responses of the listener determine the child’s success.

Conversational Partner Language does not occur in a vacuum. Children converse with many conversational partners, both at home and in school. Each partner helps form a dynamic context in which a child communicates and learns.


Part 2

Communication Assessment

Parent–child interactions usually offer an example of a communication process finely attuned to the language skills of a child. Thus, the adult–child dyad represents a highly individualized learning exchange based on the interactional styles and skills of the two communicators. These caregiver–child exchanges are reciprocal in that the child is treated as a full conversational partner and allowed to gain early conversational experience. Variables that affect language learning are complexity, semantic relatedness, redundancy, maternal responsiveness, and reciprocity. In general, maternal linguistic complexity seems to be related to the language learner’s level of comprehension. Semantically related utterances provide a contingency-based language-learning experience. The topic and subsequent content usually are derived from the child. Approximately 68 percent of a mother’s speech is related directly to the child’s verbal, vocal, and nonverbal behavior. The mother’s input tends to be highly redundant because it relates to ongoing contextual occurrences and attempts to explain, clarify, and comment on her child’s experiences and behavior. In addition, the caregiver may repeat content several times in different forms. Consistent maternal responsiveness teaches children that their responses and behavior have a predictable effect. One valuable lesson the child learns is that communication and communication partners are predictable. There is indication that some mothers of children with LI provide input that is not regulated by their children’s level of understanding, and thus it is significantly longer and more complex than their children’s level of comprehension. The mother’s average utterance length may be near that found in adult–adult communication and may include complex structures such as indirect directives, embedded constructions, and how/why questions. The proportion of utterances of mothers of children with LI that are related semantically is lower than that reported for mothers of TD children. In addition, the form of these utterances may be highly restricted, providing the child with a limited variety of input. Because few of the maternal utterances are related semantically, there is little redundancy. Instead, mothers tend to discuss events in the past or future and objects or events not present within the immediate shared context. Children with LI may have little effect on the conversational interaction, and their verbal and nonverbal behaviors may be ignored. Mothers may persist in introducing new topics, reflecting this nonchild-centered approach. Mothers of children with LI may be more dominant in conversations than are mothers of children developing typically, and they may initiate conversation and use directives more frequently (Loveland et al., 1988). In short, these interactions often lack the qualities of languagelearning conversational exchanges. There is a wide range in parents’ ability to interpret their children’s utterances correctly (Kwiatkowski & Shriberg, 1992). When a child’s utterances are unintelligible to a parent because of numerous phonological errors, the parent is more likely to use facilitative strategies, such as maintaining the topic or recasting the child’s utterance (Conti-Ramsden, 1990; P. Yoder & Davies, 1990). Thus, the parent takes control of the topic, allowing little opportunity for the child to initiate (H. Gardner, 1989). Especially when working with preschool children, an SLP should observe the conversational behavior of the primary caregiver and determine the language learning contributions. Utterances can be rated as to semantic relatedness, redundancy, and reciprocity. From these data, the SLP can comment on the overall teaching environment provided by the caregiver’s utterances and behaviors. It’s important to remember that being too directive or not responding in the most appropriate manner to enhance learning does not make a mom or dad a bad parent. By and large, parents of chil-

Chapter 6

Analysis Across Utterances and Partners and by Communication Event


dren with handicapping conditions face obstacles that you may not even be able to imagine at this point in your life. I credit parents for bringing their child to his or her present level of language functioning. I try to find where I can tweak the parent’s behavior or teach new behaviors to help the child continue that progress. Parents can become important allies, and demonizing them doesn’t aid this process.

Conclusion A language sample is a rich source of information on a child and that child’s conversational partners. Analysis may be accomplished at the individual utterance level, across utterance and across partner, and by conversational event. Analysis should not be attempted unless an SLP has a good understanding of the child’s language and of the caregivers’ concerns. Then a language sample would be analyzed to examine the portion of language in question. A conversational sample can be the best example of a child’s actual language use in context. Utterance-level analysis, discussed in the next chapter, is more appropriate for language form. Analysis of larger units, such as turns and topics, gives an SLP information on the use of language in context and answers questions about the efficacy of a child’s use of language to communicate. A caregiver’s style is also of interest if an SLP hopes to employ the caregiver as a language facilitator.



Analyzing a Language Sample at the Utterance Level

Chapter 7

Analyzing a Language Sample at the Utterance Level



In this chapter, we consider the broad analysis of language that can be accomplished easily within utterances by noting significant aspects of use, content, and form. These aspects are outlined in Table 7.1. In Chapter 6, we discussed analysis across utterances and partners and by conversational event. This three-tiered—across utterances and partners, by conversational event, and within utterances—analysis method seems appropriate for describing the interactive qualities of language use within the context of conversation. Language is not a “unitary construct,” but, rather, is multidimensional. It is the responsibility of an SLP to describe the unique character of each child’s language. Each utterance can be analyzed within use, content, and form categories following a variety of analysis formats (A. Johnson et al., 1984; Lund & Duchan, 1993). Individual utterances can yield the frequency and range of various features. Some data will be descriptive, whereas other data will be more normative. This situation reflects the research information available and the type of analysis desired. A number of computer-assisted and unassisted language sample analysis methods are available. Several are listed in Table 7.2. Although each method yields different data, none presents a total picture of a child’s language. In general, the more normative the results, the less descriptive and prescriptive, and vice versa. A few of the more widely used analysis methods are described in Appendix B. A generic analysis method might borrow useful portions from several of these.

Language Use As noted in Chapter 6, much language use data can be gleaned from analysis with units larger than the individual utterance. Within conversations, topics, and turns, however, an SLP can analyze the breakdowns in communication that occur at the utterance level. An SLP can analyze the breakdowns that occur within and the intentions of individual utterances.


Analysis at the Utterance Level

Use Disruptions Illocutionary functions and intentions Frequency and range Appropriateness Encoding Content Lexical items Type-token ratio Over-/underextensions and incorrect use Style and lexicon Word relationships Semantic categories Intrasentence relationships Figurative language Word finding

Form Quantitative measures Mean length of utterance Mean syntactic length T-units and C-units Syntactic and morphological analysis Morphological analysis Syntactical analysis Noun phrase Verb phrase Sentence types Embedding and conjoining Computer-assisted language analysis


Part 2


Communication Assessment

Language Sample Analysis Methods

Unassisted Methods Pragmatics Adolescent Conversational Analysis (Larson & McKinley, 1987) Assessing Children’s Language in Naturalistic Contexts (Lund & Duchan, 1993) Clinical Discourse Analysis using Grice’s framework (Damico, 1991a) Language functions (Boyce & Larson, 1983; Gruenewald & Pollack, 1984; Prutting & Kirchner, 1983, 1987; Simon, 1984) Syntax/Morphology Assessing Children’s Language in Naturalistic Contexts (Lund & Duchan, 1993) Assessing Language Production in Children: Experimental Procedures (J. Miller, 1981) Developmental Sentence Analysis (L. Lee, 1974) Guide to Analysis of Language Transcripts (Stickler, 1987) Index of Productive Syntax (IPSyn) (Scarborough, 1990) Language Assessment, Remediation, and Screening Procedure (Crystal, Fletcher, & Garman, 1976, revised 1981) Language Sampling, Analysis, and Training: A Handbook for Teachers and Clinicians (Tyack & Gottsleben, 1977) Semantics Profile in Semantics-Lexical (PRISM-L) (Crystal, 1982) Analysis of Propositions (APRON) (based on Johnston & Kamhi, 1984; Kamhi & Johnston, 1992; Lahey, 1988) Narratives Narrative level (Larson & McKinley, 1987) Story grammar analysis (Garnett, 1986; Hedberg & Stoel-Gammon, 1986; F. Roth, 1986; Westby, 1984, 1992; Westby, VanDongen & Maggart, 1989) Classroom-based Classroom Script Analysis (Creaghead, 1992) Curriculum-Based Language Assessment (N. Nelson, 1994) Descriptive Assessment of Writing (Scott & Erwin, 1992) Computer-Assisted Methods Syntax/Morphology Automated LARSP (Bishop, 1985) Computerized Language Analysis (CLAN) (MacWhinney, 2000) Computerized Profiling (Long & Fey, 1988, 1989) DSS Computer Program (Hixson, 1985) Lingquest 1 (Mordecai, Palin, & Palmer, 1985) Parrot Easy Language Sample Analysis (PELSA) (F. Weiner, 1988) Pye Analysis of Language (PAL) (Pye, 1987) Systematic Analysis of Language Transcripts (SALT) (J. Miller & Chapman, 2003)

DISR U PTIONS Communication breakdown or disruption can occur for many reasons. The amount and type of disruption will vary with the language task, topic, and partner(s). In general, more breakdowns occur in narration than in conversation. In addition, the longer the utterance, the more breakdowns present (MacLachlan & Chapman, 1988). Disruptions tend to occur at the developing edge of the child’s

Chapter 7

Analyzing a Language Sample at the Utterance Level


language where production capacity is “stretched” and there’s increased risk of processing difficulty. These utterances are of particular diagnostic significance (Rispoli & Hadley, 2001). Children with LI experience more disruptions than TD children. The frequency of disruptions is inversely related to subjective impressions of communicative competence (Damico, 1985). More disruptions are equated with less competence. In addition, disruptions can be a valuable clue to a child’s process of forming an utterance and to the level of cognitive and linguistic demands made on the speaker (Dollaghan & Campbell, 1992). Obviously, this type of analysis is not needed for all children with LI but may be helpful for those with word-finding problems or with “tangled,” slow, or too long utterances. Analysis requires that an SLP transcribe all words and word portions and all speechlike vocalizations. Pauses of 2 seconds or more also should be noted. Pauses should be obvious on a timed transcript format, as suggested in Chapter 5. All mazes should be identified. Mazes are language segments that, like physical mazes, disrupt, confuse, and slow movement—movement of the conversation in this case. Mazes may consist of silent pauses, fillers, repetitions, and revisions. Traditional syntactic analysis occurs after most mazes are eliminated and only well-formed sentences remain, this deprinting on SLP of data are communication breakdown. Analysis steps may consist of the following (Dollaghan & Campbell, 1992): 1. Identify disruptions by the categories in Table 7.3. 2. Determine the overall frequency of disruption and the frequency for each category. Each occurrence counts as one disruption. Frequency can be calculated per 100 unmazed words. Examples are included in Table 7.4. 3. Compare the frequencies to the rough normative data for school-age children and adolescents. Mean performance per 100 unmazed words: Fewer than two pauses of 2 or more seconds duration. Fewer than two repetitions. Fewer than one revision. Fewer than one orphan (see Table 7.3). Fewer than six disruptions overall. 4. Note variation in different communication situations.

• • • • •

Scoring and analysis will require training and practice. Reliability can be attained with repeated practice by two or more SLPs working side by side and comparing their analyses. I NTE NTIONS At the individual utterance level, pragmatic analysis can describe the intentions expressed and understood. The appropriateness and form of these intentions are also of interest. Although there is little normative data on the sophistication of intention form, each intention can be analyzed for its form and means of transmission. Frequency and Range Very little normative data are available on the frequency and range of intentions. This paucity reflects the contextual variability of intentions and the lack of agreement by professionals on the intentions expressed at various ages. Intentions are heavily influenced by and heavily influence the conversational context.


Disruption Analysis Categories



Definition and Example

Pauses Filled

Place in ()

Conventional, but nonlexical, one-syllable filler vocalizations. Example: (um), (er), (ah)


Colon & seconds

Silent interval of 2 seconds or more.* Example: Then we :3 Then we went home.

Pause strings

( ) & silent marker

Silent and filled pauses in succession. Example: So he (a-a-a-) :4 he (a-a-a-) :3 he

Repetitions Forward


Repetition of incomplete linguistic unit that is then completed. Example: Mom said we, Mom said we could go too. [RPF]



Repetition of incomplete unit with no completion. Example: So we did eat fast, did eat. [RPP]



Repetition of previously complete unit. Example: Mom said you have to go home, you have to go home. [RPE]



Repetition with additional word(s) inserted prior to repetition. Example: We went to, I mean, we went to school. [RPB]


Revision to correct overt incorrect information. Example: We saw monk . . . horses. [RVE]

Revisions Purposes Correct error

Add information [RVA]

Revision to add more information for better comprehension. Example: And this man he gonna cut . . . he was a doctor [RVA] . . . cut open . . .

Delete information


Revision to delete information for better comprehension. Example: She had cows and horses on . . . no, just cows [RVD] on her . . .



Revision for unknown or mysterious reason. Example: She gave the cookies to the kids, to them kids. [RVM]

Domain affected Lexical


Change in vocabulary. Example: She love my puppies, kitties. [L]



Change in syntax or morphology. Example: She love, loves [G] my puppies.



Change in phonology or articulation. Example: She woves, loves [P] my puppies.



Change in more than one domain. Example: She wove, loves [M] my puppies.


Seemingly unrelated stray sound(s). Example: Then man b-b-b [OP] go to . . .



Seemingly unrelated stray word(s). Example: He take, eat, dog for a walk.

Word(s) and phoneme(s)


Seemingly unrelated stray word(s) and phoneme(s). Example: I b-b-boy [OS] walk every day.

Orphans Single phoneme or string

*2 seconds is an arbitrary length. Adult pauses are much shorter. Source: Adapted from Dollaghan & Campbell (1992).

Chapter 7


Analyzing a Language Sample at the Utterance Level


Sample of disruption analysis

Partner: Do you help your parents at home? Child: My daddy, my daddy [RPE] . . . :03 I help my daddy with, my daddy to work [RVE][G]. Partner: Oh, you help your dad? What do you do? Child: He work in, outside [RVA][L] in a garden. Partner: What do you do in the garden? Child: Pull weeds and pick (um) matoes, tomatoes [RVA][P]. Partner: Um-m, I love tomatoes. I have tomato plants in my garden, too. What else do you do? Child: I do the leave stuff, the leave stuff with the [RPP] . . . :02 oh, you know [RPB] . . . :03 the thing that go like this and the leaves. Partner: You rake the leaves. Child: Yeah, and I sit, no, jump [RVE][L] and my sister. Partner: You jump on your sister? Child: Yeah, in the leaves, in the pile of leaves [RVA][G].

A number of taxonomies of intentions are available, reflecting different ages and contextual situations. I have attempted in Tables 7.5 and 7.6 to demonstrate possible changes over time. As an SLP, you may wish to develop a taxonomy based on one or a combination of the taxonomies presented. The range of intentions becomes wider and more complex with increasing age. In addition, with maturity, a child may express multiple intentions within a single utterance. Thus, a more mature speaker’s ability to express different functions is more flexible. With maturity, a speaker discusses more emotions and feelings, including such phrases as “I think . . . ,” and provides justifications. After selecting the most comfortable taxonomy or combination of taxonomies, an SLP rates each utterance of a child and conversational partner for the intentions expressed. Of interest are the conditions under which each intention occurred, possible environmental cues, and the discourse demands, such as the type of discourse (dyad, group) and nature of the task (motor, verbal, visual, or tactile) (Audet & Hummel, 1990). The normative data available, though only limited, do demonstrate that within a conversation, partners use a wide range of intentions; no intention predominates unless warranted by the situation. A child developing typically will initiate conversation and reply to the initiations of the partner, seek information and provide it, ask for assistance, and volunteer information. In contrast, some children, such as those with ASD, may initiate communication only rarely and respond with minimal replies (Loveland et al., 1988). Occasionally, adults or children fall into perseverative patterns of communicating, for example, a parent who constantly quizzes her or his child to name the pictures in a book or a child who keeps repeating a pleasing or tantrum phrase. Such behavior can skew the data or allow one type of intention, such as answers, to predominate. These patterns should be noted during conversational sample collection, and the situations gently changed. The use of different situations and different partners may ensure a better distribution of intentions. Some children, such as the incessant questioner, use only a limited range of illocutionary functions. If this behavior persists across a number of situations and partners, the SLP can be reasonably certain that this narrow range of functions represents the child’s typical behavior.


Part 2


Communication Assessment

Illocutionary Functions of Children

Early Symbolic (below age 2)

Symbolic (age 2–7 years)

Dore (1974), Owens (1978)

R. Chapman (1981), Dore (1986), Folger & Chapman (1978)

Requesting action

Requests (for) Action/assistance/objects

Form: Command, demand

Form: Question, command, embedded command, indirect request, suggestion Permission

Regulation Protesting

Regulation Protesting Rule setting

Requesting information

Requesting information Form: Choice (yes/no), product (what, which, who . . .) Process (how, why . . .)

Replying Continuants

Replying Acknowledgments Qualifications Agreements Comments Assertives

Comments Naming

Identifications Descriptions

Personal feelings

Personal feelings Statements Reports Evaluations Attributions/details Explanations Hypotheses Reasons Predictions


Declarations Procedurals Choice making Claims

Choice making Answers

Answers Providing information Form: Choice, product process Clarification Compliance Conversational organization

Chapter 7

Early Symbolic (below age 2)


Analyzing a Language Sample at the Utterance Level


Symbolic (age 2–7 years)

Attention getters Speaker selection Rhetorical questions Clarification requests Boundary markers Politeness Exclamations




Elicited imitations

Note: As children become older, they add new functions and continue to diversify those they already possess.

Appropriateness A very narrow intentional range may indicate inappropriate use of language. The question of appropriateness must be judged against other factors, such as age, race or ethnicity, region of the country, socioeconomic status, gender, and, most important, the communication context. The language sample can confirm the caregiver’s observation that “John seems to ask questions all of the time, even when he knows the answers.” Although the observation may not be unfounded, only data from the language sample can offer concrete proof.


Intentions and Age of Mastery

Within Brown’s Stage I (MLU 1.0-1.99) (Usually prior to 24 months)

Answering/Responding Continuance Declaring/Citing Making choices Naming/Labeling Protesting/Denying Repeating

Emerging within Brown’s Stages II and III (MLU 2.0-3.0) (Usually at 24–36 months)

Calling/Greeting Detailing Predicting Replying Requesting assistance/Directing Requesting clarification Requesting information Requesting objects

After Brown’s Stage III (MLU 3.0 +) (Usually after 36 months)

Expressing feelings Giving reasons Hypothesizing

Sources: Compiled from Carpenter & Strong (1988); Owens (1978).


Part 2

Communication Assessment

A child who responds inappropriately may not know the linguistic context and may need more contextual cues. For example, children with LI have more difficulty responding to wh- questions than do children developing typically (Parnell, Amerman, & Harting, 1986). These children have more difficulty with both the accuracy and the functional appropriateness of their answers. Analysis of both of these types of errors is discussed in the section on contingency in Chapter 6. In general, children with LI fail to recognize the request for information inherent in questions. Even relatively simple What + be questions, such as “What is your favorite TV show?” are difficult when they concern nonimmediate or noncontextual referential sources. Thus, analysis of the context within which questions are asked is as important diagnostically as the analysis of the variety of wh- questions produced and comprehended. Encoding Intentions can be analyzed by using a means of transmission format, such as verbal/vocal/nonverbal (F. Roth & Spekman, 1984a). The transition from linguistic through paralinguistic to nonlinguistic can be used to describe a hierarchy of competency or effectiveness based on a child’s developmental level. The nonlinguistic context and behaviors of the conversational partners must also be transcribed to make this information available. In general, a child with poor linguistic skills will rely on other means of communicating intentions. Although some very sophisticated information can be communicated nonlinguistically, as in the popularly named pregnant pause, less mature language users tend to depend on nonlinguistic and paralinguistic means more than do mature users. As with the various intentions expressed, a range of transmission means should be exhibited by the child and partner. If a child uses an augmentative form of communication, that form should be specified even more and might include physical manipulation of an object, physical manipulation of a partner, gestures, and signing or use of an augmentative device. Two children described as nonverbal may have very different means of communicating their intentions.

Content The understanding of word meanings and word relationships is affected by many factors, such as age, gender, and regional and racial/ethnic differences. To know a word is to know more than just a definition. It means a child understands that word’s relationship to similar words of meaning and sound and to words of an opposite meaning and understands the semantic class into which the word can be placed. Meaning extends beyond the word, however, and larger units of analysis, such as the phrase or sentence, also must be considered. What is said—for example, “Don’t hit me”—may be very different from the intended message, which might be “Go away, I don’t understand what you want.” Obviously, all of this information cannot be ascertained from a brief language sample. Word understanding can be assessed across several sessions by playing games like Simon Says or by directing a child through a series of tasks. The SLP can make statements in which words obviously are used incorrectly in order to judge the child’s reactions. Word games that solicit definitions or antonyms also can provide valuable information. Sorting and categorization tasks can be part of a play situation and can provide information on the child’s ability to categorize and classify. The child can be asked to name the members of a category or to deduce the category name from a list of members. The SLP can play the “fool” and make ridiculous comparisons (“A mouse is bigger than an elephant”) or silly pairings (“The comb goes between his toes”) to gauge the child’s reactions.

Chapter 7

Analyzing a Language Sample at the Utterance Level


Vocabulary abilities are strongly related to reading comprehension (Curtis, 1987; Nagy & Herman, 1987). Reading and writing analysis is discussed in Chapter 13. The child with semantic difficulties also may exhibit academic and reading failure, especially with Comprehension. Although children with LI and with LD usually do not have difficulty with referent-symbol tasks, such as those represented by the Peabody Picture Vocabulary Test, they may have difficulties, with double meanings, abstract terms, synonyms, and nonliteral interpretation (Seidenberg & Bernstein, 1986). In addition, the physical setting can be especially important for children with LI because they depend on the context for support. The child may understand a word only given certain physical situations or contexts. It may be best to assess definitions in formal decontextualized activities, such as testing, but word use in conversations, where context can influence behavior, can also indicate correct usage. Between ages 5 and 10, the nature of definitions changes from functional to categorical and more elements are added. By second grade, 49 percent of definitions include categorical membership, such as an apple is a fruit, increasing to 76 percent by fifth grade (Nippold, 1995). Multiple definitions are more difficult to interpret in a decontextualized or isolated format because of the use of content to disambiguate (C. Johnson, Ionson, & Torreiter, 1997). In general, sentence format aids performance but this varies with word type. Words with multiple definitions appear frequently. For example, 72 percent of the 9,000 most frequent words in one elementary reading series had multiple meanings. LEXICAL ITE MS Obviously, there are several levels of semantic analysis relative to individual words and relations between words and larger units. At the word level, a child demonstrates individual word meanings and word classes. Several questions arise relative to word use and the range of meanings and relationships. Norms are difficult to establish, especially for older school-age children and adolescents because of the individualistic nature of lexical growth. In addition, increases in vocabulary occur at a slow and steady pace into adulthood. School-age children and adolescents exhibit semantic development in the following areas (Scott, Nippold, Norris, & Johnson, 1992): of literate verbs, such as interpret and predict • Comprehension Comprehension textbook terms, such as invertebrate and antecedent • Comprehension ofof adverbs magnitude, such as slightly and unusually • Comprehension of adverbialofconjuncts, as meanwhile and conversely • Comprehension of sarcasm based on its such linguistic as well as intonation • Comprehension of slang terms used by peers, suchaspects, as phat • Comprehension of complex proverbs • Comprehension of complex metaphors • Explanation of infrequently occurring idioms, such as to vote with one’s feet • Explanation of ambiguous messages • Definition of abstract concept words, such as courage and justice • Type-Token Ratio The type-token ratio (TTR) is the ratio of the number of different words to the total number of words. The number of different words (NDW) in a sample of fixed length is strongly correlated with age and


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Communication Assessment

measures of semantic diversity (J. Miller, 1991). Significantly lower values than those in Table 7.9 might suggest retrieval problems or poor vocabulary. The total number of words (TNW) also increases steadily with age and is a general measure of verbal productivity (J. Miller, 1991). For example, 3-year-olds use 205 words in 50 utterances, while 8-yearolds use 379. Although a general measure of ease of language use, TNW also is affected by other factors, such as motor ability and word retrieval. For these reasons, the validity of TNW as a measure of preschool language development has been questioned by some professionals (Gavin & Giles, 1996). (Values of TNW for a 20-minute sample are listed in Table 7.9) As a quantitative measure, TTR has had a checkered past of professional acceptance. This uncertainty reflects recognition that the value may vary widely with the language sample size. In general, less variability is found across larger samples of 350 words or more (Hess et al., 1986). Multiple settings and more representative samples would yield theoretically more stable values, although there may be great situational variability for an individual child (Hess, Haug, & Landry, 1989). Children between ages 2 and 8 demonstrate TTRs of 0.42 to 0.50 (Klee, 1992). Children who receive values greater than 0.50 have greater variability and flexibility in their language, whereas those below 0.42 tend to use the same words over and over again. Very low values may indicate perseverative or stereotypic behavior, word-retrieval problems, or restricted vocabulary. Children with LEP also may score lower because of their lack of English vocabulary. A low value may indicate overreliance on words with broad application but unspecified meaning (empty words), such as thing and one. Children with poor vocabularies or word-finding difficulties may use empty words, rather than more specific words that are not at their disposal. Two spontaneous language profiles emerge from the samples of children with word-finding problems (German, 1987). Some children exhibit word-finding difficulties both on structured naming tasks and in spontaneous samples. They exhibit reformulations, time fillers, empty words, repetitions, starters, and grammatical errors. Other children with LI exhibit these behaviors only on structured naming tasks, although they produce relatively less language in spontaneous samples than do children developing typically. Mature speakers should possess a variety of words for describing sensory experiences, such as sight (clearly), sound (loud), smell (stunk), and feelings (happy, tired). They should be able to describe the environment in terms of time (at five o’clock) and location (in front of). Entities should possess physical qualities, such as shape (sort of round), size (big), number (two, many, few), substance (metal, wood), and condition (new, ragged). There should be terms for relationships, such as comparisons (bigger than, as big as) and qualifications (nearly, not quite, only, enough); and verbs for describing actions (run, jump, eat), states (am, is, are), and sensory processes (feel, hear, see). Finally, the speakers should be able to describe causation (because . . .) and motivation. As noted previously, these terms develop slowly. The full range is characteristic of the mature speaker. Deictic terms, or terms that must be interpreted from the perspective of the speaker (e.g., here, there, this, that, come, go), offer a special problem for the child with LI. The shifting reference that occurs with each speaker change contributes to the child’s difficulty. Children with LLD, ASD, or emotional disturbances may lack either the listener or speaker perspective. These children also may refer to themselves by name and may echo the utterances of others. No one measure, such as type-token ratio, should be used in isolation. This is especially true for children from CLD backgrounds. Although type-token and its component parts, total number of words and number of different words, can be used to differentiate the narratives of typical language from impaired language for monolingual children, they do not do so for bilingual Spanish-English preschool

Chapter 7

Analyzing a Language Sample at the Utterance Level


children (Muñoz, Gillam, Peña, & Gulley-Faehnle, 2003). Other measures, such as syntactic accuracy, may be more appropriate. Over-/Underextensions and Incorrect Usage An SLP should note all inaccurate uses of words that indicate some variation between a child’s meaning and the conventional one. In general, meanings mature from the concrete, personal, experiential ones found in preschool children to the shared, conventional, abstract ones of adults. Some children use words incorrectly because they do not know the shared conventional definition. Others use word substitutions that are incorrect. For example, a recent letter from a young adult with LD included the following: I wish I could write as good as you. You know where to put paragraphs and how to use punctuality [my italics] right. Because I am usually late, I assume he meant punctuation. Further testing by an SLP can reveal the basis of a child’s substitutions. The child may miss the target word slightly, as in the above example, or may have word-finding difficulties, resulting in word substitutions. Children with LEP may use L2 words in either very restricted or overextended ways. Restricted use may be limited to specific features of a word or to word-for-word transfer in which the word has only the meaning of its L1 equivalent. In the latter, for example, the English for, which is para in Spanish and has slightly different syntactic uses, might be used only where para would be used. Style and Lexicon Children begin to use different styles of talking relatively early. Analysis across utterances and partners might highlight a conversational style shift. These changes can be analyzed further for the vocabulary used in different styles. Slang is a casual manner of spontaneous conversation among peers and is important for adolescents. Used appropriately, slang separates adolescents from children and adults and establishes group identity and solidarity (Cooper & Anderson-Inman, 1988). Certain vocabulary—rad, phat, bad—is characteristic of adolescent slang. Word meanings change quickly and are invented often by youth (R. L. Chapman, 1987). Knowledge of slang vocabulary increases with age, with boys knowing more terms for vehicles and money and girls for clothing, boys, and unpopular individuals. An adolescent with LI may seem odd in peer situations because he or she underuses or overuses adolescent slang or uses it inappropriately. Although difficult to assess because of its changing nature and subgroup use, slang is, nonetheless, extremely important. In brainstorming sessions, TD teens can suggest vocabulary targets for assessment and training. The child’s literate vocabulary, consisting of words primarily used in common academic contexts, is also important. A good, literate lexicon is needed to achieve academic success, especially among adolescents (Nippold, 1993). Possible lexical items are analyze, criticize, deduce, define, infer, interpret, predict, remember, and understand. Classroom teachers can suggest other useful literate terms. WOR D R E LATIONSH I PS Each word in a language is related to other words. These relationships consist of word associations (e.g., salt and pepper or king and queen), synonyms, antonyms, and homonyms. Some of these associations


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Communication Assessment

are expressed in a conversational sample, whereas others need to be probed by an SLP. These associations reflect underlying cognitive organizational strategies. Semantic Categories Semantic categories, such as agent, action, and location, are the earliest word classes children use. Indeed, most of the early language development of toddlers is concerned with semantic units. Several categorization schemes attempt to describe the semantic classes of young children and adults. Table 7.7 is a composite of the range of semantic categories expresssed by children that SLPs are interested in. Semantic knowledge, the underlying concepts, may be a better framework than language form for assessment children with minority dialects, including African, Latino, and Asian American English and Appalachian English. The adequacy of the semantic knowledge of these children is often questioned on the basis of the form of their language. It is assumed, incorrectly, that minority dialect speakers acquire concepts later than do speakers of dialects closer to Standard American English (SAE). The developmental trends are very similar and suggest guidelines for assessment of the semantic features of speakers of minority dialects (Stockman & Vaughn-Cooke, 1986). Intrasentence Relationships In addition to an interest in a child’s word meanings and relationships, an SLP investigates other relationships expressed in the sentence through the use of conjunctions, negatives, and prepositions (Lund & Duchan, 1993) and various sentence forms, such as passive voice. Conjunctions Four types of conjunctive relations are expressed in conjoined sentences (Bloom, Lahey, Hood, Lifter, & Fiess, 1980): additive, temporal, causal, and adversative. In the additive form, two clauses with no dependent relationship simply are joined to one another. In the sentence “Julio ate pie, and Brigid drank coffee,” neither event depends on the other for its existence. In the temporal form, one clause depends on the other to precede or follow or occur at the same time. In “I’m going to the store before I go to the party” or “I’ll rake the leaves while you finish painting the trim” the timing of the clauses is clearly stated. Causal conjoining implies a dependency in which one clause is the result of the other, for example, “I went to the party because I was invited.” The preschool child may use because alone or at the beginning of a clause, as in “Cause I want to,” although true causal conjoining occurs much later (see Table 7.16). Finally, in adversative conjoining, one clause contrasts with information in the other, as in “I read the article, but I was unimpressed.” One clause opposes or negates the other.

TABLE 7.7 Semantic Function


Semantic Categories



The predicate expresses action with a transitive or intransitive clause.

We grew pumpkins and squash. (Transitive) She gave us a dollar. (Transitive) He swims daily. (Intransitive)

Chapter 7

Semantic Function

Analyzing a Language Sample at the Utterance Level




The predicate makes a statement about the way things are with a transtive, intransitive, or equative clause.

I want a hot fudge sundae. (Transitive) Tigers look fierce. (Intransitive) She is tall. (Equative) My sister is now at Harvard. (Equative)

Agent or actor

Animate instigator of action. Sometimes inanimate, especially if natural force. Usually the subject but may also be passive complement.

Mike threw the ball. Termites destroyed our cabin. Wind blew down the trees. The cat chased the dog. The dog was chased by the cat.


Usually refers to the inanimate object used by the actor to effect the action stated in the verb. The actor is usually not stated but may be. The instrument function may also be adverbial, as in on his drum.

The axe split the wood. The building was erected by a crane. She used the baseball bat with great skill. The axe split the wood. The shaman kept rhythm on his drum.


The entity on which an action is performed. The patient may be a direct object in transitive clauses or the subject in intransitive clauses.

Mike threw the ball. The lighthouse withstood the hurricane.


The animate recipient of action. Usually the indirect object but may also be the direct object if it does not undergo any action but receives something.

Father bought mother a bouquet of roses. Our mascot brought us good luck. He built a treehouse for his daughter. I loved that movie.


Fulfills the adverbial function of time in response to a when question. May also be the subject of a sentence or a complement.

I’ll see you later. We’ll meet at four o’clock. Then, I’ll know. Tomorrow is a holiday. Tuesday will be our first meeting. It is time to leave.


Fulfills the adverbial function of place in response to a where question. May also be the subject of a sentence or a complement.

Some of us looked in the old log. I knew it was right here. Chicago is indeed a windy city. Our house has three bedrooms.


Fulfills the adverbial function of manner in response to a how question.

We stalked the big cat carefully. He worked with great skill.


Fulfills the adverbial function of with X in response to with whom or with what questions.

He swam with his sister. She left with Jim. He hunted with his dogs.

Empty subjects

Serve a grammatical function.

It was sunny. There may be some rain.

Source: Adapted from Chafe (1970); Fillmore (1968).



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Negatives Negatives may be expressed in several ways and develop at different stages. The four mature negative forms include (a) not and -n’t; (b) negative words, such as nobody and nothing; (c) the determiner no used with nouns; and (d) negative adverbs, such as never and nowhere. Again, the more mature language user should have a variety of forms. Those used by the child can be compared with the developmental data available in Table 7.16. Prepositions Prepositions are some of the hardest working and most versatile English words. They can be used to mark location (in the box), time (in a minute), or manner (in a hurry) to fill adjectival and adverbial functions, and to make figurative expressions. These small, often unstressed words may be misinterpreted or misunderstood by children with both LI and LEP. A strategy they use is overreliance on one form. As mentioned previously, an SLP examines the sample for the breadth of use. Passives In general, children with LI exhibit difficulty interpreting sentences in which the information might be interpreted in a reverse manner (van der Lely & Harris, 1990). For example, a passive sentence, such as “The cat is chased by the dog” might be interpreted incorrectly as “The cat chased the dog” by using a agent-action-object interpretation strategy. Children with LI have difficulty interpreting the grammatical functions of words and integrating grammatical and semantic information. FIG U RATIVE LANG UAG E Nonliteral meanings used for effect are more characteristic of school-age and adult language than of preschool language (Nippold, 1988; Nippold & Martin, 1989). Examples include metaphors, similes, idioms, and proverbs. For the purposes of analysis, jokes and puns also can be considered figurative language. Figurative language occurs frequently in oral conversation and written texts and interpretation of idioms is highly correlated with reading ability. Children as young as 31⁄2 are able to comprehend some idioms, especially the more literal ones (Abkarian, Jones, & West, 1992). In general, figurative interpretation increases with increasing age. Individual interpretive ability is related to each person’s world knowledge (Winner, 1988). For example, smooth sailing has more meaning for the child who has some boating experience. Idioms occur frequently in the classroom. There may be as many as four figures of speech per speaking minute. Teachers use idioms in approximately 11 percent of their utterances, while third- to eighth-grade reading programs contain idioms in approximately 6.7 percent of their sentences (Lazar, Warr-Leeper, Nicholson, & Johnson, 1989). Idioms differ greatly in their difficulty of interpretation. In general, more familiar and more transparent or guessable idioms are easier. The child’s world and word experience appear to be a key factor in interpretation (Nippold & Rudzinski, 1993). An SLP considers the range of figurative language used. Some children overrely on well-worn phrases and expressions, with little knowledge of their actual meaning. Such expressions as these can be probed by an SLP to determine a child’s actual knowledge. Comprehension and production of idioms might be analyzed on the basis of decomposability of the idiom. Decomposable or analyzable idioms can be broken easily into their component parts. For example, pop the question or let off steam can be broken into components that each contribute to the overall meaning, as follows: pop the question

pop = act of uttering questions = marriage proposal

Chapter 7

let off steam

Analyzing a Language Sample at the Utterance Level


let off = release steam = energy

Nondecomposable idioms, such as kick the bucket, are difficult to break into components. Comprehension depends on a child’s intuition about the internal semantics of the idiom. In general, young children are better able to interpret decomposable idioms than nondecomposable. Third and fourth graders do equally well on both types in context. If no contextual information is available, these children also are better able to comprehend decomposable idioms (Gibbs, 1991). Analysis of figurative language is especially important for children with LEP. Idiomatic expressions may be interpreted literally and/or based on cultural interpretation. WOR D FI N DI NG Word-finding difficulties are an impaired ability to generate a specific word that is evoked by a situation, stimulus, sentence context, or conversation. In Chapter 3 we discussed a method of probing for word-finding difficulties and strategies. In Chapter 6 we noted that latency may signal such difficulties. Other symptoms include frequent pauses, repetitions, circumlocutions, fillers, nonspecific words, frequent pronouns, and high usage of cliches and routinized expressions, such as you know (Bates et al., 1988; Snyder & Godley, 1992). Inaccurate naming may be analyzed using the strategies presented in Table 3.7. Word-finding difficulties relate to several aspects of the target words, such as word frequency, age of acquisition, familiarity, and lexical neighborhood (German & Newman, 2004). Neighborhood density, or the number of words that differ from the target word by only one sound, is particularly important. Words such as rat have many neighbors: cat, bat, fat, gnat, sat, hat, mat, rap, ran, rot, wrote/rote, write/right, rate, and so on. The neighborhood is very dense. Both children and adults find it easier to produce and remember words that are phonologically similar to words already known. If neighbors are high-frequency words, recall is enhanced even more. In contrast, word substitutions tend to be words that have a higher frequency, are learned earlier, and also reside in dense neighborhoods with other high-frequency words. Blocked words, or those a child is unable to retrieve, tend to reside in sparse neighborhoods. Phonological errors tend to occur on rare words and those whose neighbors contain lower frequency, uncommon phonological patterns. Several intrinsic and extrinsic variables affect word-retrieval skills. Intrinsic variables include the frequency of occurrence of the word, familiarity with the word, age of acquisition, category, and degree of abstractness. In general, more frequently used, more familiar, earlier learned, and less abstract words are easier to retrieve (Stowe, 1988). Words from large prototype categories, such as fruits and vegetables, are easier to retrieve than those from well-defined categories, such as months, based on a small set of specific features. In actual use, categories overlap and relative importance for naming will vary. Extrinsic variables include the context, syntactic requirements, type of stimulus and manner of presentation, priming, and use of categories. In general, sentence contexts are easier than picture ones, which, in turn, are easier than definitions. Formulation of more difficult sentences, however, interferes with word recall, probably because of the greater cognitive energy needed to form the sentence. Priming results when preceding words aid recall (Balota & Duchek, 1989; Glass & Holyoak, 1986). Finally, use of subordinate categories can aid word recall (Kail, Hale, Leonard, & Nippold, 1984). The effect of these variables can be very important and difficult to assess in a language sample. It is important, therefore, to use familiar partners, topics, and situations to facilitate retrieval.


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Communication Assessment

Form Language form includes syntax, morphology, and phonology, or the means used to encode the intentions and meanings of a speaker. Even though most language analysis methods concentrate on this aspect of language, very little normative data is available. The task is partially normative and partially descriptive, involving both quantitative and qualitative analysis. Several available analysis methods are described in Appendix B. A discussion of phonological analysis is beyond the scope of this text. QUANTITATIVE M EASU R ES Quantitative measures include mean length of utterance (MLU), mean syntactic length (MSL), T-units and C-units, and the density of sentence forms. Each is discussed in some detail. The SLP must be cautious with all word and morpheme counts. Careful editing of utterances is required so that interjections, false starts, and the like are not included in the count. Circumlocutions, or talking around an unretrievable word, actually may increase the length of the child’s utterances. It is recommended that an SLP follow consistent rules for counting. For example, incomplete words, nonessential repetitions, revisions not containing a complete thought, unintelligible words and phrases, and fillers might be offset in brackets and not counted. These structures are retained, however, for disruption analysis. Quantitative measures may present some problems (Scott & Stokes, 1995). In general, there can be wide variability across children and situations. In addition, many values change only slowly with age. Still, average words per sentence values increase from 7 to 14 between third and twelfth grade. Combinations of quantitative data may yield better information than individual bits of information. For example, MLU, percentage of utterances containing one or more errors of morphology or syntax, and chronological age seem to be optimal for predicting clinical diagnosis of SLI (Dunn, Flax, Sliwinski, & Aram, 1996). Structural errors might include word misordering; omission or incorrect use of a morpheme; omission of articles, auxiliary verbs, or contractions; use of telegraphic speech; or incorrectly selected negatives. Children between the ages of 49 and 53 months may have MLU values of 4.1 compared to 3.12 for those with SLI. The percentage of utterances with structural errors is 10.97 and 23.56 respectively. Mean Length of Utterance Mean length of utterance is the average length in morphemes of the speaker’s utterances. Up to an average of 4.0, MLU is considered a good measure of language complexity. Not all linguists agree (J. Johnston & Kamhi, 1984; Klee & Fitzgerald, 1985; Lahey, 1994). Although the reliability of MLU has been questioned and the values vary in response to SLP input, MLU has been shown to be both a reliable and valid measure of general language development through age 10 for children with SLI (Rice, Redmont, & Hoffman, 2006). In general, there is less variability in MLU below 4.0 (Rondal, Ghiotto, Bredart, & Bachelet, 1987). This mean is reached by the nonimpaired child at around age 4, but MLU continues to increase with age. At lower MLUs, new structures added to the child’s utterances increase the complexity of those sentences. After this level of development, much of the growth in complexity is the result of internal reorganization of utterance form, rather than addition of new structures. This explanation of the relationship between length and complexity is extremely simplified, and there are many related factors.

Chapter 7

Analyzing a Language Sample at the Utterance Level


To calculate MLU, an SLP divides the language sample into utterances. It is best not to include in analysis the portions of conversation that occurred while the child was adjusting to the partner or to the situation. The number of morphemes in each utterance is counted and totaled for the entire sample. Rules for counting morphemes on the basis of the order of development with nonimpaired children are included in Table 7.8. Brief rationales for these rules are included where appropriate. The total number of morphemes for the entire sample is divided by the number of utterances from which it was derived to determine the MLU. This value then can be compared to the age data in Table 7.9. It is obvious from the table that a wide variability and a wide range of ages are considered


Rules for Counting Morphemes Relative to the Speech of Preschool Children





Each recurrence of a word for emphasis

No, no, no.

1 each

Compound words (2 or more free morphemes)

Railroad, birthday


Compound words learned as a unit by preschoolers

Proper names

Bugs Bunny, Uncle Fred


Proper names, even those with titles, learned as a unit by preschoolers

Ritualized reduplications

Choo-choo, Night-night


Irregular past tense verbs

Went, ate, got, came


Verb tense learned as new word by preschoolers, not as verb + ed


Doggie, horsie


Phonological form CVCV easier than CVC for preschoolers and does not denote smallness

Auxiliary verbs and catenatives

Is, have, do; gonna, wanna, gotta


Preschoolers do not know that such words as gonna are going to

Contracted negatives

Don’t, can’t, won’t


Because negatives don’t, can’t , and won’t develop before do, can, and will, count as one until the positive form appears. Then count the negative forms as two morphemes. All other negatives—couldn’t—count as two.

Possessive marker (-’s)

Tom’s, mom’s


Plural maker (-s)

Cats, dogs


Third-person singular present tense marker (-s)

Walks, eats


Regular past tense marker (-ed)

Walked, jumped


Present progressive marker (-ing)

Walking, eating



C-c-candy, b-b-baby



Um-m, ah-h


Count only the final complete form.*

*In the example “I want can . . . I want can . . . I want candy,” only the last full reduction is counted, being three morphemes.


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Communication Assessment

within the normal range. Even so, the need to collect a typical sample is very important. If data have been collected in two or more settings, the MLUs from each can be compared to assess the stability of the overall data. Although age and MLU are correlated as shown in Table 7.9, some interesting data suggest cautious acceptance of this correlation. First, the relationship of rate of MLU change and age is not a constant, as seen in Table 7.9. Second, some language impairments are not evidenced by delays in MLU as might be expected (Klee, Schaffer, May, Membrino, & Mougey, 1989). As with any single measure, MLU alone is a poor diagnostic tool and the validity and reliability of results will vary with the sample size (Eisenberg, McGovern Fersko, & Lundgren, 2001). Standard errors of measure may differ .19 at 18 months to .71 at 60 months based on a 50-utterance sample. Values are less for 100 utterance samples. Nor is a low MLU necessarily indicative of language impairment. Utterance length may vary with the situation, and some children with LI, especially those with circumlocution or empty words, may have inflated MLUs. Mean Syntactic Length Mean syntactic length (MSL) is the mean length in words of all utterances of two words or more—those utterances with some internal grammar. This measure eliminates all one-word responses, such as yes/no answers. MSL seems to correlate more strongly than MLU with age (Klee & Fitzgerald, 1985). Values for MSL are listed in Table 7.9 (Klee, 1992). TABLE 7.9

Quantitative Measures of Language

Age in Months


*Range of Mean MLU

18 21 24 27 30 33 36 39 42 45 48 51 54 60 108

1.1 1.6 1.9 2.1 2.5 2.8 3.1 3.3 3.6 3.8 3.9 4.1 4.3 4.4 8.8

1.0–1.2 1.1–1.8 1.6–2.2 1.9–2.3 2.4–2.6 2.7–2.9 3.0–3.3 3.2–3.5 3.3–3.9 3.4–4.3 3.6–4.7 3.7–5.1 3.9–5.8 4.0–6.0 7.2–10.4***


**TNW (20 min.)

**NDW (50 utt.)

2.7 2.9 3.1 3.4 3.7 3.9 4.2 4.4 4.7 4.9 5.2

240 286 332 378 424 470 516 562 608 654 700

36 41 46 51 56 61 66 71 76 81 86

TTR (type-token ratio) changes little with age but is in the range .42–.5 for 2- to 9-year-olds. *Combined data from four different studies (Klee, Schaffer, May, Membrino, & Mougey, 1989; J. Miller, 1981; Scarborough, Wyckoff, & Davidson, 1986; Wells, 1985) **MSL (mean syntactic length), TNW (total number of words), and NDW (number of different words) extrapolated from tables in Klee (1992). ***From J. Miller, Freiberg, Rolland, & Reeves (1992)

Chapter 7

Analyzing a Language Sample at the Utterance Level


T-Units and C-Units Expressive language syntax of older children and adolescents can be measured in T-units (minimal terminal units), consisting of one main clause plus any attached or embedded subordinate clause or nonclausal structure (discussed in the following section). Thus, the unit has shifted from the utterance to the sentence in its shortest allowable form. Any simple or complex sentence would be one T-unit, but a compound sentence would be two or more. For example, the sentences “I want ice cream” and “I want the one that is hidden in the blue box” each constitute one T-unit with varying numbers of words and clauses. “I want the ice cream in the picture, and he wants a shake” consists of two main clauses and thus two T-units. Examples of T-units are given in Table 7.10. The T-unit is more sensitive than MLU to the types of language differences seen after age 5, such as phrasal embedding and various types of subordinate clauses. Throughout the school years, a slow but regular increase occurs in sentence length in both oral and written contexts. Children’s language can be described in words per T-unit, clauses per T-unit, and words per clause. A gradual and progressive increase in words and clauses per T-unit and in words per clause in spontaneous speech occurs with increased age throughout childhood and adolescence, although the values change only gradually during early school years (see Table 7.11) (Klecan-Aker, 1985; Scott et al., 1992). The values for spoken words/T-unit and clauses/T-unit are similar for Spanish. To calculate these values, the SLP divides the sample into sentences, each equaling one T-unit. The number of words and clauses then can be determined for each and divided by the number of T-units to calculate an average. The words per clause can be determined similarly. It should be noted that the type of conversational task will influence some T-unit measures. Information-giving tasks increase the words and clauses per T-unit. In addition, at this level of development, T-unit values can be misleading because complexity and length are not directly related. For example, among adolescents, phrases may be used in place of subordinate clauses for conciseness, suggesting greater syntactic sophistication (Nippold, 1993). These include participial phrases (Working until midnight, John missed his bus), infinitive phrases (Candace was not afraid to use the computer for typing her assignment), and gerund phrases (Seeing your photos convinced us that we should go to Puerto Rico) (Scott, 1988b).

TABLE 7.10

Examples of T-Units and C-Units

Sentence Structure


Number of T-units and C-units

Simple—one clause

They watched the parade on TV.

1 T-unit, 1 C-unit

Complex—embedded clause

Washington has the horse I want.

1 T-unit, 1 C-unit

Compound—conjoining of two or more clauses

They went to the movie, but I stayed home. Mom went to work, I went to school, and my sister stayed home.

2 T-units, 2 C-units

(Who went with you?) Marshon. Oh, wow! A penny saved.

1 C-unit 1 C-unit 1 C-unit

Partial sentences Elliptical answers Exclamations Aphorisms

3 T-units, 3 C-units


Part 2

Communication Assessment

A variance of the T-unit is the C-unit. C-units are similar to T-units but also include incomplete sentences in answer to questions (Table 7.10). C-unit values are given in Table 7.11. The length increase in C-units is primarily through the increased use of low-frequency structures. These include post-noun modifiers, such as apposition structures (Mary my instructor showed us . . .) and prepositional phrases (The man in front is . . .), complex nominals (Dogs and cats can . . . or Rules such as stop on red are . . .), and elaborated verb tensing, such as modal auxiliaries (could have been), perfect aspect (had been working), and passive voice (The window was broken by a fly ball). Analysis of these structures might accompany calculation of C-unit values. Although data are not complete, some values for T-units and C-units have been calculated for children speaking primarily African American English and Spanish. These are presented in Table 7.11. Children speaking AAE demonstrate infinitive phrase embedding and clausal embedding at an early age. Three-year-olds have one or more complex syntactic forms in 6.2 percent of their utterances, while 4-years-olds increase that to 11.7 percent (Jackson & Roberts, 2001). Additional values include mean number of morphemes per C-unit for AAE speakers (Craig, Washington, & Thompson-Porter, 1998): Age 4 5 6 Preschool Kindergarten

TABLE 7.11

Mean Morphemes/C-Unit 3.48 3.76 4.24 3.55 3.98

T-Units and C-Units by Age and Grade


Words/T-unit Spoken Oral Spanish Written Words/C-unit Oral Oral AAE Written Clauses/T-unit Spoken Written Subordinate Clauses/C-unit Spoken Written Words/Clause Spoken Written

Age 4

Age 6

Grades 3–4


Grades 6–7

Grade 9


Grades 10–12


5.64 9.5












1.31 1.3

1.5 1.6 .37 .29


1.5 1.6–1.8 .43 .47

.58 .6

7.75 7.26

Source: Adapted from Crowhurst & Piche (1979); Scott, Nippold, Norris, & Johnson (1992).


Chapter 7

Analyzing a Language Sample at the Utterance Level


Number of errors per T-unit was also found to be a significant value for predominately Spanish-speaking children (Restrepo, 1998). Five- to 7-year-old Spanish-speaking children developing typically made only .09 (S.D. = .05) errors, while those with LI made .39 (S.D. = .21).

SYNTACTIC AN D MOR PHOLOG ICAL ANALYSIS Many children with LI experience difficulty with syntax and morphology. For example, children who are mildly to moderately behaviorally disordered seem to have word-order difficulties (Camarata, Hughes, & Ruhl, 1988). It should be noted that some utterances defy analysis, such as those containing contrasting stress used to negate. For example, one speaker might say, “Penny went,” only to be corrected by the other speaker with “Mary went.” At a syntactic level, these two sentences would appear to be similar. Morphological Analysis An SLP is interested in intraword development, as well as in sentence development. With preschool children, the SLP will want to analyze Brown’s fourteen morphemes for correct production. These are listed in Table 7.12. Other morphemes, such as pronouns, also may be of interest. Older children may use a variety of morphological prefixes and suffixes. A list of the more common prefixes and suffixes is included in Appendix C. Correct usage of Brown’s fourteen grammatical morphemes can be a clinical aid for establishing the developmental stage of preschool children (J. Miller, 1981). Table 7.12 presents the morphemes by stage of mastery, the stage in which each morpheme is produced correctly by children in 90 percent of the obligatory contexts. The percentage correct value is determined by dividing the number of correct appearances by the total number of obligatory contexts. In obligatory contexts, the child might use the morpheme correctly, make an error substitution, or omit the morpheme. Table 7.13 presents selected portions of a language sample and the calculation of percentage correct for the regular plural marker. The percentage correct yields only limited data. More descriptive information can be gained. For example, an SLP who calculated only the percentage correct for past-tense -ed still would not know whether errors were related to nonuse of -ed where required or to use of -ed on irregular past tense verbs. The pronoun error analysis format in Table 7.14 offers guidance for analysis with other forms. After calculating percentage correct, an SLP can attempt to describe the child’s stage of language development as outlined in Table 7.13. This process is not an exact science. Rarely is the determination clear-cut or is one and only one stage identified. Morphological markers are applied to word classes. For example, the past tense marker -ed is confined to verbs. Therefore, an SLP should also note word classes in which errors occur. Occasionally, errors are confined to only one word class, such as verbs. Nouns would be affected by such markers as plural regular and irregular, possessive, and articles. Verb markers include third-person singular, past tense regular and irregular, present progressive, modals, do + verb, copula (am, are, is, was, were), and perfective (have + be + verb). Finally, adjective and adverb markers include, but are not limited to, comparative (-er) and superlative (-est) and adverbial -ly. Pronouns offer a special case of morphological analysis because of the complex nature of the underlying semantic and pragmatic functions. If the child’s strategy is “when in doubt, use the noun,”


Part 2

TABLE 7.12

Stage of Mastery





Communication Assessment

Brown’s Fourteen Morphemes and Age of Mastery



Age Range of Mastery* (in months)

Present progressive -ing. (no auxiliary verb)

Mommy driving



Ball in cup



Doggie on sofa


Regular plural -s

Kitties eat my ice cream. Forms: /s/, /z/, and /lz/ Cats (/kæts/) Dogs (/d⊃gZ/) Classes (klæslz), wishes (/wlʃlz/)


Irregular past

Came, fell, broke, sat, went


Possessive ’s

Mommy’s balloon broke. Forms: /s/, /z/, and /lz/ as in regular plural


Uncontractible copula (verb to be as main verb)

He is. (response to “Who’s sick?”)



I see a kitty. I throw the ball to daddy.


Regular past -ed

Mommy pulled the wagon. Forms: /d/, /t/, and /Id/ Pulled (/pυld/) Walked (/w⊃kt/) Gilded (/g l al d ld/)


Regular third person -s

Kathy hits. Forms: /s/, /z/, and /lz/ as is regular plural


Irregular third person

Does, has


Uncontractible auxiliary

He is. (response to “Who’s wearing your hat?”)


Contractible copula

Man’s big. Man is big.


Contractible auxiliary

Daddy’s drinking juice. Daddy is drinking juice.


*Used correctly 90% of the time in obligatory contexts. Source: Adapted from R. Brown (1973); J. Miller (1981).

Chapter 7

TABLE 7.13

Analyzing a Language Sample at the Utterance Level


Calculating Percentage Correct for Plural



2. Want more cookies.



3. Three cookie. 4. No, one big cookies. 22. Dogs.


27. Give the pencils to me.


28. I want two pencils.


31. You color the foots. 48. What blue crayons?




Percentage correct =

Type of Error

Totalof correct Totalof correct +incorrect




Placed on singular


Placed on irregular

3 =

5 8

= 62.5%

then it will be difficult to find errors in pronoun substitution (Haas & Owens, 1985). More in-depth analysis is required, possibly similar to that presented in Table 7.14. The types of errors made may reveal the underlying rules that the child is using. When analyzing the oral and written language of school-age children and adolescents, an SLP will want to note the scope of prefix and suffix use. In addition to inflectional suffixes, such as plural -s and past-tense -ed, derivational suffixes also should be analyzed. These suffixes, more common in written than in oral language, are used to change word classes, as in adding -er to a verb such as teach to create the noun teacher. The two most common derivational changes are from verbs to nouns (paint to painter) and from verbs to adjectives (run to runny) (Scott, 1984, 1988b). Children with CLD Backgrounds An SLP should be mindful of dialectal and bilingual variations. Even though a child omits a morphological ending, it cannot be assumed that the child does not understand or is not able to produce the morpheme. For example, children who speak African American English may omit some word endings for phonological reasons. Others are omitted because they are redundant, such as the plural -s when the noun is preceded by a number as in ten cent. The child’s abilities must be established by the testing of both the marker and the concept associated with it. The standard for comparison of children’s performance is the communication community of each child. A child’s language is impaired to the extent that he or she is unable to communicate effectively in that community. Two errors that occur in language assessment are (a) mistaking dialectal variations for disorders and (b) overlooking disorders mistakenly assumed to be dialectal variations. In general, dialectal variations develop by age 5, with a few noticeable at age 3 (Battle, 1990). Language sampling analysis of bilingual Spanish-English children should consider code switching, dialectal differences, English proficiency, and the effects of context on a child’s language performance (Gutierrez-Clellen, Restrepo, Bedore, Peña, & Anderson, 2000).

TABLE 7.14

Possible Pronoun Analysis Method Sub-analysis of Incorrect Responses

I me

III (MLU: 2.5–3.0)

IV (MLU: 3.0–3.75)

V (MLU: 3.75–4.5)

Post V (MLU: 4.5+)



Percent Correct


I (MLU: 1.0–2.0) II (MLU: 2.0–2.5)









Ambiguous Reference

Overuse of Nominal

my it (subj.) it (obj.) you (subj.) your she them he we her (poss.) his him you (obj.) us they our its myself yourself her (obj.) their herself himself ourselves themselves TOTAL

Comments: Note: Pronouns, arranged by stage of acquisition, are scored as correct or incorrect, although the total and percent columns are initially left blank. Incorrect pronoun use is then analyzed as a substitution or omission error. Substitution may be multiple, as when she is used for his, demonstrating substitutions of case and gender. When this step is completed, the sample is checked to ensure that the referent has been clearly identified for each pronoun and that the child has not overused the referent name in place of a pronoun. These are also errors, and once noted, they should be added to the incorrect total on the left. When this step is completed, the total and percent correct columns can be completed.

Chapter 7

TABLE 7.15

Analyzing a Language Sample at the Utterance Level


Frequent Morphological Errors of Speakers with LEP


Type of Error

Possible Explanation


Omission or overgeneralization of the

Articles are used infrequently in many languages.

Auxiliaries and modals


Many languages do not have auxiliary verbs and rely on verb markers.



Unstressed forms often omitted; a phonological error.



Unstressed forms often omitted.


Omission of -ing ending

Many languages do not have this form.

Plural -s

Omission or error in agreement, as in many tree

Unstressed forms often omitted; used when other languages mark by adjective.

Possessive -’s

Omission or overgeneralization

Many languages use the possession of possessor form.


Substitution errors

Very complex system in English; multiple meanings of words.


Substitution errors, nounpronoun agreement errors

Most languages do not have as many pronouns as English.

Regular past -ed

Omission or overgeneralization

Unstressed forms often omitted.

Third-person -s

Omission or overgeneralization

Exception to English rule of no person or number markers.

The most frequent morphological errors of speakers with LEP are presented in Table 7.15. Morphological markers often are omitted or overgeneralized. Some Spanish speakers lump English syllables together, decreasing intelligibility. A Cuban American friend calls me “Bobowens.” This chunking may cause small units such as morphemes to be deemphasized or omitted. Syntactic Analysis Analysis also is accomplished at the intraclausal and clausal levels. For this type of analysis, it is best to exclude imitations, short answers to questions, and stereotypic or rote responses because these types of utterances are not usually clinically significant. For analysis purposes, it is helpful to separate sentences and nonsentences. Sentences are grouped as declarative, negative declarative, imperative, negative imperative, interrogative, and negative interrogative. Sentences can be grouped for further analysis by length or structure. For example, declarative sentences can be categorized as subject-verb, subject-verb-object, subject-verb-complement, and multiple clauses, either embedded or conjoined. The form of a preschool child’s sentences can be compared with normative data, such as those in Table 7.16, to best determine the child’s stage of development, although descriptive data are also valuable. The SLP should note intrasentential noun and verb phrase development, sentence types, and embedding and conjoining. These and other sentence analyses are especially important for school-age children and adolescents.

TABLE 7.16

Preschool Language Development and Brown’s Stages


Early I (MLU 1–1.5)

Approximate Age

12–21 mos.

Sentence Types


Single words. Yes/no questions use rising intonation. What and where. Negative + X. Semantic word-order rules.

Pronouns I & mine. Isolated nouns elaborated as art./adj. + noun. Serial naming without and.

Late I (MLU 1.5–2.0)

21–26 mos.

S + V + O appears. Negative no and not used interchangeably. Yes/no question form is This/that + X?

And appears. In & on appear.

Early II (MLU 2.0–2.25)

27–28 mos.

Wh- question form is What/where + noun? To be appears as main verb.*

Present progressive (-ing), no aux. verb mastered by 90%. Pronouns me, my & it, this & that. Nouns elaborated in object position only [(art./adj./dem./poss.) + noun].

Late II (MLU 2.25–2.5)

28–29 mos.

In/on & plural -s mastered by 90%.

Early III (MLU 2.5–2.75)

30–32 mos.

Basic SVO used by most. Negative element (no, not, don’t, can’t interchangeable) placed between noun and verb. What/where + N + V? Inversion in What/where + be + N?* S + aux. verb + V + O appears. Aux. verbs include can, do, have, will.

Gonna, wanna, gotta, hafta appear. Pronouns she, he, her, we, you, your, yours, & them. Noun elaboration in the subject & object position [art. + (modifier) + noun]. Modifiers include a lot, some & two. Select irregular past (came, fell, broke, sat, went) & possessive (-’s) mastered by 90%.

Late III (MLU 2.75–3.0)

33–34 mos.

S + aux. verb + be + X appears. Negative won’t appears. Aux. verbs appear in interrogatives: inverted with subject in yes/no type.

But, so, or, & if appear.

Early IV (MLU 3.0–3.5)

35–39 mos.

Negative appears with aux. verb + not (cannot, do not). Inversion of aux. verb and subject in Wh- questions.

Uncontractible copula (verb to be as main verb) mastered by 90%. Pronouns his, him, hers, us, & they. Noun phrase elaboration includes art./dem. + adj/poss./mod. + noun. Clausal conjoining with and appears. Clausal embedding as object with think, guess, show, remember, etc.

Late IV (MLU 3.5–3.75)

39–42 mos.

Double aux. verbs in declaratives. Add isn’t, aren’t, doesn’t, and didn’t. Inversion of be and subj. in yes/no interrogatives. Add when and how interrogatives.

Articles (the, a), regular past (-ed), & third person regular (-s) mastered by 90%. Infinitive phrases appear at end of sentence.

Stage V (MLU 3.75–4.5)

42–56 mos.

Indirect objects appear in declaratives. Add wasn’t, wouldn’t, couldn’t, shouldn’t. Negative appears with other forms of be. Some simple tag questions appear.

Pronouns our, ours, its, their, theirs, myself, & yourself. Relative clauses appear attached to object. Infinitive phrases with same subj. as main verb.

Post-V (MLU 4.5+)

56+ mos.

Add indefinite negatives (nobody, no one, nothing), creating double negatives. Why appears in more-than-one-word interrogatives. Negative interrogatives after 60 mos.

Irregular past (does, has), uncontractible auxiliary to be and contractible auxiliary to be and copula (to be as main verb) mastered by 90%. Remaining reflexive pronouns added. Multiple embedding; embedding + conjoining. Relative clauses attached to subj. appear.



Part 2

Communication Assessment

The SLP can use Table 7.16 in a comparative fashion. For example, let us assume that a child said, “I want a big doggie.” The noun doggie has been expanded by the addition of an article and an adjective. This noun phrase occurs in the object position of the sentence. Expansion of the noun phrase in the object position is an example of structure occurring at Stage II and above, according to the intrasentential column of Table 7.16. The verb is unelaborated, as is the subject noun. These represent structures at the Stage I level or above. No further analysis is needed for sentence type. The child with LEP may not exhibit difficulty in a sentence-by-sentence analysis. Analysis of connected speech beyond the sentence may provide more insight. Word-order errors and cohesive difficulties become evident in analysis of units larger than the individual sentence. Noun Phrase Noun phrase elaboration is assessed by describing the number and variety of noun phrase elements. Analysis of noun phrases is especially appropriate for children in late childhood or adolescence. The order of the elements within the noun phrase is relatively fixed, although the order of development is not. The noun function is obligatory, and the other modifiers are nonobligatory. Some or all of these elements may be present in the noun phrase, as shown in Table 7.17. Some elements may be used in combination, whereas the use of others is more exclusive. Initiators consist of a small core of words that limit or quantify the phrase that follows. Examples are only, a few of, and merely. Most of these words can serve also as adverbs. The SLP must be careful to identify the accompanying noun phrase in order to avoid adverb-initiator confusion. Determiners come in many varieties and include, in order of mention, quantifiers; articles, possessive pronouns, and demonstratives; and numerical terms, such as two, twenty, or one hundred. Quantifiers include such words as all, both, half, twice, and triple. In combination with initiators, determiners can yield nearly all, at least half, and less than one-third. Articles include common forms such as the, a, and an. Possessive pronouns include my, your, and their and are used without articles. Demonstratives serve as articles but are interpreted from the perspective of the speaker as in this, that, these, and those. Adjectivals consist of nouns marking possession, as in mommy’s; ordinals, such as first, next, and final; adjectives, such as little, big, and blond; and nouns used as descriptors, as in hot dog stand and cowboy hat. Thus, a speaker might say, “Brother’s first little cowboy hat.” The exact order of adjectivals in a noun phrase is more complex, requiring more explanation than space allows; however, most speakers recognize that Cowboy little first brother’s hat is incorrect. The noun function can be filled by subjective pronouns, such as I, you, and they; objective pronouns, such as me, you, and them; genitive pronouns, such as mine, yours, and theirs; simple singular and plural nouns, such as boy, girls, and women; and mass nouns that have no distinction between singular and plural, as in sand, water, and police. When a pronoun is used, the noun to which it refers usually has already been identified, and the noun phrase is relatively simple. The noun function also may be complex or may consist of a phrase, as in Statue of Liberty, need to succeed, and city of Los Angeles, or a compound, as in Jim and Bob and duty and responsibility. Finally, if the noun is understood by both the speaker and the listener, it may be omitted, as in the following exchange: “What did you and Barb do last night?”“(We) Went to that movie at the mall.” Post-noun modifiers may take many forms, including prepositional phrases (in the gray flannel suit), embedded clauses (who lives next door), adjectivals (next door and driven by my mother), and adverbs (here and there). Post-noun modifiers may be used singly or in combination—for example, “The man who lives in the green house on the next block bought all of the candy that I was selling.”

TABLE 7.17

Elements of the Noun Phrase



+ Adjectival

+ Noun

+ Post-Noun Modifier

Only, a few of, just, at least, less than, nearly, especially, partially, even, merely, almost

Quantifier: All, both, half, no, onetenth, some, any either, twice, triple Article: The, a, an Possessive: My, your, his, her, its, our, your, their Demonstrative: This, that, these, those Numerical Term: One, two, thirty, one thousand

Possessive Noun: Mommy’s, children’s Ordinal: First, next, next to last, last, final, second Adjective: Blue, big, little, fat, old, fast, circular, challenging Descriptor: Shopping (center), baseball (game), hot dog (stand)

Pronoun: I, you, he, she, it, we, you, they, mine, yours, his, hers, its, ours, theirs Noun: Boys, dog, feet, sheep, men and women, city of New York, Port of Chicago, leap of faith, matter of conscience

Prepositional Phrase: On the car, in the box, in the gray flannel suit Adjectival: Next door, pictured by Renoir, eaten by Martians, loved by her friends Adverb: Here, there (embedded) Clause: Who went with you, that you saw

Examples Nearly . . . . . . . . . . . . . . . . . . all the one hundred . . . . . . . . . . . . . . . . . old college . . . . . . . . . . . . . . . . . . . alumni . . . . . . . . . . . . . . . . . . . . . attending the event Almost all of . . . . . . . . . . . . her thirty . . . . . . . . . . . . . . . . former . . . . . . . . . . . . . . . . . . . . . . . clients Just . . . . . . . . . . . . . . . . . . . . half of your . . . . . . . . . . . . . . brother’s old baseball . . . . . . . . . . . . . . . . . . uniforms . . . . . . . . . . . . . . . . . . . in the closet


Part 2

Communication Assessment

The development of elements of the noun phrase takes most typically developing children many years and continues into adolescence. As noted in Table 7.16, elaboration begins in isolation and then moves to the object position in the sentence before appearing in the subject position. This pattern is only the beginning of the development process; with increasing age, the child should use more and more noun elaborations. Adjectives and determiners appear at the two-word stage for both children with LI and those without. Initiators and post-noun modifiers appear later, with children with LI exhibiting a marked delay. For children developing typically, clausal post-noun modifiers appear in late Stage IV and V (See Table 7.16). Most 5-year-olds use no more than one modifier with each noun. Thus, most internal development of the noun phrase occurs in later childhood and adolescence. Both elaborated pre-noun and post-noun modification, using relative clauses and prepositional phrases, develop during this period (Nippold, 1993; Perera, 1986a, 1986b; Scott, 1988a, 1988b). The most elaborated forms usually are produced in written language. An SLP is interested in the distribution of these elaborations in these positions and the average number of morphemes within noun phrases. It may be helpful for an SLP to use a format of analysis similar to that in Table 7.17. Children with LI can be expected to have simpler, less elaborated noun phrases. Pronouns offer a special problem. Children with LEP may exhibit confusion with modifier order and pronoun use. Verb Phrase As mentioned in Chapter 2, verb morphology is particularly difficult for children with SLI. Analysis of verb phrase construction and inflected morphology can be a useful measure for identifying 31⁄2- to 6-year-olds with SLI (Bedore & Leonard, 1998). Verb phrase elaboration consists of the verb and associated words, including noun phrases used as complements or as direct or indirect objects. An SLP is concerned with the verbs used and those that are missing or incomplete. Other elements of the verb phrase that are present or absent are also important and reflect the maturity of the speaker’s language system. Predicate or verb relationships take three forms: intransitive, in which the verb cannot take an object as in she walks; transitive, in which the verb can take an object as in to her; and equative, which consists of the copula (to be) plus a complement of a noun, adjective, or adverb as in they are students, they are young, or they are late respectively. Verb phrases can be described by the length and range of types, as demonstrated in Table 7.18. Simple transitive (Mommy throw) and equative verb phrases (Doggie big) appear at an MLU of about 1.5 (Kamhi & Nelson, 1988). At this stage, the verbs are unmarked for tense or person, and the copula is omitted. As language becomes more complex, verbs become marked, the copula appears, and intransitive verb phrases appear. By Stage II, the progressive -ing marker and catenatives (gonna, wanna, gotta, hafta) appear. The perfective form (have + verb-en) and the passive voice begin to be used by Stage IV. Adverbial phrases also appear in Stage IV. Late childhood and adolescent language development is characterized by increasing verb complexity with the use of auxiliaries, (do, have) modals (may, should), and perfective forms, such as have been going. There is also increasing use of adverbs and adverbial phrases, such as prepositional phrases of manner (in silence), place (in the city), and time (in a week) (Scott, 1984). In general, even children with LI who exhibit these more complex structures tend to use them less frequently than do children developing typically. Tense markers are used to describe the temporal relationships between events. For example, if the event being described is taking place while the speaker mentions it, the speaker uses the present progressive verb form (auxiliary + verb-ing) to indicate an ongoing activity (walking, eating). In contrast,

Chapter 7

TABLE 7.18

Analyzing a Language Sample at the Utterance Level


Elements of the Verb Phrase

Modal Auxiliary

+Perfective Auxiliary

May, can, shall, will, must, might, should, would, could

Have, has, had

+ Verb to be

+ Negative*

+ Passive

+ Verb

Am, is, are, was, were, be, been


Been, being

Run, walk, eat, throw, see, write

+ Prepositional Phrase, Noun Phrase, Noun Complement, Adverbial Phrase

On the floor, the ball, our old friend, a doctor, on time, late

Examples: Transitive (May have direct object) May . . . . . . . . . . . have . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . wanted. . . . . . a cookie Should . . . . . . . . not . . . . . . . . . . . . . . . . . . . . . . . . throw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . the ball in the house Intransitive (Does not take direct object) Might . . . . . . . . . . have . . . . . . . . been . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . walking . . . . . to the inn Could . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . not . . . . . . . . . . . . . . . . . . . . . . . talk . . . . . . . . with you Equative (Verb to be as main verb) . . . . . . . . . . . . . . . . . . . . . . . is . . . . . . . . . . . . not . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a doctor . . . . . . . . . . . . . . . . . . . . . . . was . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . late . . . . . . . . . . . . . . . . . . . . . . . were . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on the sofa May . . . . . . . . . . . . . . . . . . . . . . . . be . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ill * When model auxiliaries are used, the negative is placed between the model and other auxiliary forms, for example, “Might not have been going.”

the perfect form of the verb (have + verb-en) indicates that the action is being described in relation to the present. Thus, “I have been working here for two years” implies that this action is still occurring, whereas “I have eaten my dinner” implies that the action is now complete. Verb tense analysis can be accomplished in a form similar to that presented in Table 7.18. Table 7.16 identifies the ages at which most preschool children acquire auxiliary and modal auxiliary verbs. Irregular past tense verbs are a special problem (Shipley, Maddox, & Driver, 1991). English contains approximately 200 irregular verbs. Although many are used infrequently, words such as went, saw, sat, and ate, are among the most frequently used verbs. Development begins in the preschool years and extends into adolescence. Their irregular nature precludes rule learning and generalization, and most acquisition is by rote (Shipley & Banis, 1989). Some morphophonemic regularities do occur, however, and may influence the relative ease of learning (Shipley et al., 1991). The least difficult verbs to learn are those that exhibit no change from present to past, such as cut/cut and hurt/hurt. The most difficult seem to be those with a final consonant change from /d/ to /t/, as in build/built (Shipley et al., 1991). Other morphophonemic changes include internal vowel change (fall/fell, come/came), vowel


Part 2

Communication Assessment

change with added final consonant (sweep/swept), total change (go/went), and vowel change with a final dental consonant (ride/rode, stand/stood). Obviously, other factors, such as the concept expressed (semantics) and the sounds involved (phonology), also affect learning. Table 7.19 presents the ages at which 80 percent of children are able to use different irregular verbs in a sentence completion task. In addition to manner and result, adverbs, like verbs, also mark temporal relations. Temporal relations can be expressed between two events (before, next, during, meanwhile), with the continuation of an event (for the past year, all week), in the recent past (recently, just a minute ago), and with repetition (many times, again). Verb aspect indicates temporal notions, such as momentary actions, duration, and repetition. Momentary actions are of short duration (fall, break, hit). In contrast, duration is marked by verbs of longer action with definite beginnings and ends (sleep, build, make). Phrases also may be used to convey a definite act (sing a song) and an act without a well-defined terminal point (sing for your own enjoyment). Still other verbs describe repetitive actions (tap, knock, hammer). All these characteristics affect verb learning. The development of tense markers seems to be related to the temporal aspect of each verb. The SLP should investigate the relationship between tenses the child uses and the verbs to which these tenses are applied. No doubt, a full analysis will require something larger than a 50- to 100-utterance sample. Modal auxiliary verbs, such as can, could, will, should, shall, may, might, and must, are used to express the speaker’s attitude (Bliss, 1987). Syntactically, modals function in the formation of questions (Can we go tonight?) and negatives (I shouldn’t go out in this weather.) They are used also in such statements as “I will do it tomorrow.” As with the pronoun system, modals represent a complex interaction of form, content, and use that is reflected in the slow rate of acquisition, which usually lasts from age 2 to age 8. Semantic categories of modals include wish or intention (will, would), necessity or obligation (must, should), ability or permission (can), certainty (will), and probability or possibility (may, might) (Bliss, 1987).

TABLE 7.19

Irregular Verbs and Age of Acquisition

Age in Years

Irregular Verbs

3:0 to 3:5 3:6 to 3:11 4:0 to 4:5 4:6 to 4:11 5:0 to 5:5 5:6 to 5:11 6:0 to 6:5 6:6 to 6:11 7:0 to 7:5 7:6 to 7:11 8:0 to 8:5 8:6 to 8:11

Hit, hurt Went Saw Ate, gave Broke, fell, found, took Came, made, sat, threw Bit, cut, drove, fed, flew, ran, wore, wrote Blew, read, rode, shot Drank Drew, dug, hid, rang, slept, swam Caught, hung, left, slid Built, sent, shook

Source: Adapted from Shipley, Maddox, & Driver (1991).

Chapter 7

Analyzing a Language Sample at the Utterance Level


Those modals associated with action, such as can and will (ability, intention, and permission request), are acquired first. During the third year, the number of modals and the categories increases. After age 4, the child clarifies the different forms and their uses. Children with LI rarely use modal auxiliaries, possibly because they lack the linguistic subtleties expressed. In general, children with LI have more difficulty with catenatives (gonna, wanna), modals, and auxiliary verbs than their language level would suggest. An SLP is interested in the range and frequency of the types of verbs a child exhibits. Children with CLD backgrounds may experience difficulty with verb tense and with auxiliary verbs. Irregular past tense verbs may exhibit substitutions (I go yesterday.) Verb endings may be omitted as a general phonological rule pattern. Verb-subject agreement is also difficult (She go every day). When analyzing a sample, an SLP pays particular attention to the level of development, the range of semantic concepts, the variety of usage, and the types of errors (Bliss, 1987). Variety of usage is noted with different pronouns, verb tenses, negative and positive statements, and sentence types. Sentence Types A single event may be described by the agent that originates the action, the action or state changes, and/or the recipient or object of that action (Duchan, 1986b). In English, the agent as a noun or a noun phrase is usually first, followed by the action word or verb, which in turn is followed by the recipient or object of that action in the form of a noun or a noun phrase (“John threw the ball” or “Mother will eat the cookie”). If the agent performs the action for the benefit of some other person, that beneficiary—the indirect object—either precedes or follows the noun phrase describing the object of the action. For example, in “He painted the picture for mother,” for mother follows the object of the sentence. Likewise, we could say, “He painted mother a picture.” Instruments used to complete the action usually are placed after the action and follow the preposition with, as in “He painted with a brush.” Sentences that differ from the predominant subject-verb-object English format may be difficult for the child with LI to decipher and form. Often, overreliance on the S-V-O strategy is not noted until the child begins school. The child with LI may resist rearrangement or interruption of this form and may attach other structures only at the beginning or the end. Yes/no questions may be asked with rising intonation, rather than through transformation of the subject and verb elements (He is sick? vs. Is he sick?) Passive sentences, which use an object-action-agent form, may be misinterpreted. An SLP is interested in the range of internal sentence forms and in the different sentence types. Sentence types include positive and negative forms of the declarative, interrogative, and imperative. Declarative sentences are statements (“He likes ice cream” or “She does not want to go”). Interrogatives include three types of questions, including yes/no, wh- or constituent, and tag. The form of yes/no questions may vary from a statement with rising intonation (“You went to the store?”) to a subject-verb reversal using the copula or an auxiliary verb (“Is he happy?” or “Did she eat her pie?”). Wh- questions begin with such words as what, where, who, why, when, and how. Either the copula or auxiliary verb and the subject are reversed from their order in a statement (“What is her age?” or “Why did he go?”). A less mature form that can be used with some wh- questions places the whword at the end of the sentence (“She likes what?”) or does not reverse the subject and verb (“what he want?”) Tag questions are statements with question tags attached (“She’s lovely, isn’t she?”). These are the most difficult type.


Part 2

Communication Assessment

The preschool development of questions is given in Table 7.16. Mature tag questions, because of their complex nature and infrequent use in American English, are acquired much later than are yes/no and wh- interrogatives. Some children do not master the mature tag form until mid-elementary school (Reich, 1986). A less complex form using okay or all right (or the Canadian eh) may appear in preschool (“I do this, okay?”). The range of sentence types and the maturity of form are of interest. These are listed in Table 7.16. With more mature speakers, an SLP must consider the use of emphasis, pauses, and intonation to mark different meanings for the same form. Pauses mark the end of conceptual units and direct the listener in the type of response required. For example, “Do you like football (pause) or baseball?” requires a very different response (pick one) from “Do you like football or baseball?” (yes or no). Rising intonation is used on an entire word for unexpected or surprise events and falling intonation for the expected. As mentioned previously, rising intonation at the end of a word or a sentence also signifies a question, and falling intonation signifies a statement. Imperatives are commands (“Eat your dinner” or “Stop that”). The subject, you, is understood. SLPs must be careful not to confuse these sentence types with utterances in which a child omits the subject. The child who repeatedly omits the subject in other sentences probably should not be credited with imperative forms. The behavior of other people may be influenced also by requests. These are discussed in Chapter 5 and in the intentions section of this chapter because of the pragmatic aspects of this form. Negative sentences, whether declarative, interrogative, or imperative, also possess characteristic developmental forms (Table 7.16). The child’s first negatives are marked by no and slightly later by not. Initially, these two forms are used interchangeably. To these are added don’t and can’t, also used interchangeably, followed by won’t. Positive forms of do, can, will, and would develop later, followed by negative forms for the verb to be and for other auxiliaries. By school age, a child develops indefinite forms (e.g., no one, nothing) and indirect negative imperatives (“Watch out for the hole”). During the schoolage years, the child masters such negative prefixes as un-, non-, and ir-. Embedding and Conjoining Both embedding and conjoining involve relationships between clauses. In addition, embedding involves the relationships between phrases and clauses. A clause consists of a noun phrase and a verb phrase. A clause that can stand alone is an independent clause, or sentence, even though it contains only the noun and the verb (“John ran”). Some clauses contain both elements but are not independent. These clauses, such as “that you want,” must be attached to an independent clause or sentence in a process called embedding. In this manner, “that you want” can be embedded in “The toy is on sale” to form “The toy that you want is on sale.” Two or more independent clauses can be joined together by a conjunction, such as and or but, in a process called conjoining. It’s sometimes difficult for students to identify multiclausal sentences as conjoined or embedded. I suggest that you refer to the excellent tutorial by Steffani (2007). Her descriptions and identification flowchart are presented in Table 7.20 and Figure 7.1 respectively. Clausal embedding initially develops in the object position at the end of the sentence (Table 7.16). Called object noun complements, these dependent clauses take the place of the object following such words as know, think, and feel (“I know that you can do it”). Object noun complements using that (“I think that I like it ”) appear at an MLU of 4.0, most frequently following the verb think (Tyack & Gottsleben, 1986). By an MLU of 5.0–5.9, this type of embedding accounts for only 6 percent of chil-

Chapter 7

TABLE 7.20

Analyzing a Language Sample at the Utterance Level


Complex Sentence Descriptions and Examples



1. Full propositional complement (Object noun phrase complement): Contains a “cognitive” verb such as think, guess, wish, know, hope, wonder, show, remember, pretend, mean, forget, say, tell; may or may not contain that

I hope (that) we go to lunch soon. Forget that you did it.

2. Gerund: Contains an -ing form that functions as a noun (is not directly related to the auxiliary verb)

Swimming is fun. I felt like jumping.

3. Participle: Contains an -ing form that functions as an adjective (modifies a noun or pronoun) (is not directly related to the auxiliary verb)

I see the man driving down the street. I want the dog barking loudly.

4. Simple infinitive: Contains to followed by a verb; subject is the same as the main sentences; this does not include early developing catenatives such as gonna, wanna, gotta, sposta, hafta, let’s, lemme

I need to go. They want to sleep in the tent.

5. Infinitive clause with different subject: Contains an infinitive (to + verb); the subject of the infinitive clause is different from the main clause

I want the baby to eat. He needs the dog to go away.

6. Unmarked infinitive: Contains make, help, watch, or let without a to marker

Watch me run. Let me do it.

7. Simple wh- clause: Contains who, what, where, when, why, how ; does not contain an infinitive to marker

See how fast I am. I remember what we do.

8. Wh- infinitive: Contains a wh- word (what, where, who, how, when) and an infinitive

I don’t know what to wear. You know where to put it?

9. Relative clause: Contains an embedded phrase that functions as an adjective; modifies an object or subject noun phrase; may be marked by who, which, that

The man who is running is fast. That is the one that I like.

10. Simple conjoining: Contains two clauses that are joined by a conjunction; can be coordination (and, but, or, etc.) or subordination (because, after, etc.)

I ate fast so I could leave.

11. Embedded and conjoined: Contains both an embedded and conjoined clause; may include a catenative; will have 3 or more verbs

I like cake and I like ice cream.

Swimming is fun because I like to get wet. I want to stay here, but my mommy says no.

dren’s two-clause sentences. Object noun complements using what (“I know what you did”) account for 8 percent of these sentences. Relative clauses attached to nouns develop next, beginning in the object position, as in “I want the dog that I saw last night.” Finally, the relative clause moves to the center of the sentence, describing the subject, as in “The one that you ate was my favorite.” During late childhood and adolescence, an increase occurs in relative clauses either attached to the subject or serving as the subject, as in “Whoever wishes


Part 2

Communication Assessment

COMPLEX SENTENCES Look through the language sample/narrative and mark all the sentences that: Have 2 or more MAIN verbs NOTE: catenatives (gonna, wanna, gotta, etc.) are counted ONLY if there are 2 other verbs



is it preceded by a whword?

YES How many THREE Is there a * verbs? conjunction? or MORE NO TWO YES is there an infinitive verb (to+verb)?



How many subjects? TWO



NO is there make, help, YES watch, or let without an infinitive to marker?



FPC ***

is there a conjunction (e.g., and, or, but, so, because, after)?





is it preceded by a NO cognitive verb: YES e.g., think, wish, guess, YES is there/could there be know, hope, wonder, the word that? ** show, mean, remember, pretend, forget, say, tell? NO NO RELATIVE CLAUSE

is there the word why, where, when, or how? NO


YES is there what, is it functioning as an adjective? who, which? NO NO SIMPLE WH- CLAUSE

YES is there a verb+ing (e.g., running, jumping)? NO


** ***

Words that connect two complete sentences such as: and, or, but, so, which, because, while, if, after, before, though, although, whether, as, since, except, therefore. Example: Remember (that) you are big. Full Propositional (or Object NP) Complement

are you still looking for an answer? YES SOMETHING IS WRONG! START AGAIN.

is it connected to an auxiliary YES verb (is, am, are, was, were)?

OOPS— try again

NO is it functioning NO as an adjective?



FIGURE 7.1 Flowchart to aid in identifying conjoined and embedded complex sentences. Source: Steffani (2007). Identifying embedded and conjoined complex sentences: Making it simple. Contemporary Issues in Communication Science and Disorders, 34, 44–45. Reprinted with permission.

Chapter 7

Analyzing a Language Sample at the Utterance Level


to go should come to the office.” This type of clausal embedding is more common in written language than in oral (Perera, 1986a, 1986b; Scott, 1988a, 1988b). Relative clauses appear less frequently among preschoolers than other forms of clausal embedding, although by school age, 20 to 30 percent of two-clause sentences may be of this type. Relative clauses appear at about 48 months initially as post-noun modifiers for empty nouns, such as one or thing (Wells, 1985). The most common relative pronouns for preschoolers are that and what. During the school years, relative pronouns expand with the addition of whose, whom, and in which. Phrases also may be embedded in clauses. As in clausal embedding, phrasal embedding usually develops initially at the end of the sentence. A phrase is a group of related words that does not contain a subject and a verb and are of several types, including prepositional, participial, infinitive, and gerund phrases. Such phrases take the place of nouns or modify nouns. Prepositional phrases also may be adverbial in nature, as in “She will arrive in a minute.” During late childhood and adolescence, an increase occurs in both the number and length of adverbial phrases (Scott et al., 1992). Infinitive phrases first appear in the object position, most frequently following want (“I want drink pop”). This form with the to omitted emerges at a median age of 30 months (Wells, 1985). Infinitives with a different subject from the main verb (“Mommy, I want you to eat it”) appear somewhat later. An SLP is interested in the number and type of embeddings. Some developmental data are included in Table 7.16. The position of these embeddings within the sentence is also important, given the developmental significance of position. Clausal conjoining appears relatively late in preschool development, although some conjunctions appear much earlier. Usually, and is the first conjunction learned; it is used to join objects in a group. Throughout the preschool period, and continues to be the most frequently used conjunction, being five to twenty times more common than but (Scott, 1988a). Around 30 months of age, children begin to sequence clauses, using and as the initial word in each sentence (“And we saw ponies”). As noted in Table 7.16, and is also the first conjunction used to join clauses. At this point, and is used for sequential events and is interpreted as and then. Even among school-age children, 50 to 80 percent of all narrative sentences begin with and (Scott, 1987). With age and an increase in written communication, use of and decreases. Between ages 11 and 14, only 20 percent of spoken narrative sentences begin with and. In written narratives, the rate is only about 5 percent (Scott, 1987). Other conjunctions may express a causal relationship (because), simultaneity (while), a contrasting relationship (but), and exclusion (except). Conjunctions generally develop in the following order: and, because, when, if, so, but, until, before, after, since, although, and as (Scott, 1987; Tyack & Gottsleben, 1986; Wells, 1985). The most frequently used conjunctions through age 12 are and, because, and when. Early developing strategies that rely on the order of mention for interpretation may persist with a child with LI. Thus, a child ignores the conjunctions and their intended meanings. The sentences “Go to the market before you go to the movie” and “Go to the market after you go to the movie” are interpreted as having the same meaning because of the order of the clauses. An SLP is interested in the range and frequency of the conjunctions used and in the amount of conjoining present in the sample. This information is especially important with more mature speakers and is discussed in the following chapter on narratives. An SLP also should note multiple embeddings and embedding and conjoining that occur within the same sentence. Again, this usage is much more characteristic of school-age language than of preschool language. The narratives of children ages 10 to 12 years are easily distinguishable from those of preschoolers by the presence of multiple embedding and conjoining within the same sentence (Perera, 1986a, 1986b; Scott, 1988a, 1988b).


Part 2

Communication Assessment

Computer-Assisted Language Analysis Several computer-assisted language analysis (CLA) methods are available, each based on some particular model of language structure. CLAs provide the SLP with a quick, efficient, standard analysis routine. Most CLA formats have three common features (Long, 1991). First, all utterances must be coded to assist the computer in identifying structures. This time-consuming step may be shortened for an SLP by having an assistant make an initial transcription (J. Miller, Freiberg, Rolland, & Reeves, 1992). This transcription can be corrected and readied for analysis by the SLP. Second, the computer recognizes, analyses, and tabulates the identified structures from the transcript. Third, the program displays the results in an interpretable format. A list of available CLA syntactic and phonological software is provided in Table 7.21.

TABLE 7.21

Computer-Assisted Language Sample Analysis Software




Automated LARSP (Bishop, 1985)

Based on Language Assessment Remediation and Sampling

Computerized Language Analysis (CLAN) (MacWhinney, 2000)

Designed to analyze data transcribed in the Child Language Data Exchange System (CHILDES). Free software can be downloaded. Includes frequency counts, word searches, co-occurrence analysis, MLU counts, interactional anlysis, text changes, and morphosyntactic analysis. Based on Conversational Act Profile (Fey, 1986), Developmental Sentence Analysis (DSS) (L. Lee, 1974), Profile in SemanticsLexical (PRISM-L) (Crystal, 1982). Profile of Prosody (PROP) (Crystal, 1982), Profile of Phonology (PROPH), (Crystal, 1982). Calculates MLU and type-token ratio Uncoded transcript

Computerized Profiling (Long & Fey, 1988, 1989)

DSS Computer Program (Hixson, 1983)

Based on Developmental Sentence Analysis (DSS) (L. Lee, 1974) Coded transcript.

Lingquest 1 (Mordecai, Palin, & Palmer, 1985)

Calculates MLU and type-token ratio Coded transcript

Parrot Easy Language Sample Calculates MLU Analysis (PELSA) (F. Weiner, 1988) Coded transcript Pye Analysis of Language (PAL) (Pye, 1987)

Flexible analysis categories Coded transcript

Systematic Analysis of Language Transcripts (SALT) (J. Miller & Chapman, 2003)

Based on Brown’s Stages of Development Flexible analysis categories Calculates MLU, NDW, TNW Coded transcript

Source: Adapted from Long (1991).

Chapter 7

Analyzing a Language Sample at the Utterance Level


Once mastered, CLA is more efficient than analysis by hand; this efficiency increases as the complexity of analysis increases (Long & Masterson, 1993). Although CLAs may quicken the analysis phase of sampling, they cannot replace the clinical intuition of the trained SLP. Nor can CLAs fill the deficiency caused by a poorly collected sample. In addition, only the SLP can use the data generated to make clinical decisions.

Conclusion The conversational sample is a rich source of data about children’s language. Within utterances both qualitative and quantitative measures are possible. Obviously, such analysis is time-consuming. SLPs should analyze only areas of suspected difficulty rather than attempt a blanket analysis. Of interest is the child’s present communication system and the communication characteristics of the child’s communication partners. Unlike the larger-unit analyses discussed in Chapter 6, within-utterance measures can be compared more readily to similar data from children developing typically.



Narrative Analysis

Chapter 8


Narrative Analysis


arratives are a self-initiated, self-controlled, decontextualized form of discourse. As such, narratives are an important part of the language assessment of older school-age children and adolescents because they provide an uninterrupted sample of language that the child or adolescent modifies to capture and hold the listener’s interest (Crais & Chapman, 1987; Hewitt & Duchan, 1995; Liles, 1985a, 1985b, 1987; Scott, 1988b). The narrative speaker is responsible for ordering and providing all of the information in an organized whole (F. Roth & Spekman, 1985). Although narration and conversation share many qualities, they differ in very significant ways. First, narratives are extended units of text. Second, events within narratives are linked with one another temporally or causally in predictable ways. Narratives are organized in a cohesive, predictable, rulegoverned manner representing temporal and causal patterns not found in conversation. Third, the speaker maintains a social monologue throughout. The speaker must produce language that is relevant to the overall narrative while remaining mindful of the information needed by the listener. Fourth, narratives have an agentive focus. In other words, narratives are about agents—people, animals, or imaginary characters—engaged in events over time. Narratives are not limited to fictional storytelling, thus narrative evaluation should not consist solely of a child or adolescent recounting fairy tales or formulating stories from pictures. Oral narration includes the telling of self-generated stories, storytelling of familiar tales, retelling of movies or television shows, and recounting of personal experiences. Most conversations include narratives of this latter type. How often we begin conversations with “You’ll never believe what happened to me coming to work today,” or “Let me tell you what it means to get into a hassle.” Diagnostically, narratives are good for eliciting a variety of complex syntactic structures (Gummersall & Strong, 1999). The narratives of children with LD and TBI are shorter and less mature and have less mature episode and sentence structure than those of age-matched TD peers (S. Chapman, 1997; Merritt & Liles, 1987, 1989; F. Roth & Spekman, 1986). Students with LD demonstrate knowledge and use of story elements but convey and recall less information. In addition, children with LD retrieve less information and make fewer inferences than do TD children. Although the stories of children with LD contain all of the elements in the generally appropriate order, they are substantially shorter and contain fewer and more poorly organized complete episodes (Liles, 1990). Episodes are also less likely to be related linguistically (F. Roth & Spekman, 1985). In addition, more statements of children with LI are not integrated into the episode structure (Liles, 1990). This paucity of information may reflect a lack of presuppositional skills (F. Roth, 1986). Possibly because of the communication demands placed on the child in narration, the narratives of children with LD exhibit a greater rate of communication breakdown (MacLachlan & Chapman, 1988). Although children with LD use conjunctions and unambiguous reference, they are less efficient in their use than TD peers (Liles, 1985a). In general, children with LD often fail to consider the needs of their audience (Liles, 1987). The internal story organization of children with LI is also less complete than that of age-matched TD peers (Merritt & Liles, 1987) and contain more statements that are not integrated into the episode structure. Usually, these children have difficulty describing and manipulating props and activities (Sleight & Prinz, 1985). Oral and written narratives should form a portion of any child’s language assessment. The results should be compared with a child’s other linguistic abilities prior to making judgments on the adequacy of the child’s language system.


Part 2

Communication Assessment

Scripts and Narrative Frames Narratives are an expression of the organization and interconnection of data in the brain. The storyteller must construct a context within which to relate events, both real and imaginary. Narratives consist of two frameworks, scripts and story frames (Naremore, 2001). Scripts consist of typical, predictable event sequences formed on the basis of experience, either real or vicarious. Scripts are not about any one experience but are generalized, organized hierarchically and causally, inhabited by characters, and contain a predictable sequence of events. Each event is represented in the brain and becomes part of a generalized event sequence, such as birthday parties. Narrative frames are mental models of story structures. We use them to facilitate production and comprehension of narratives. In short, narrative frames are mental organizers that reduce processing demands. The narratives of children with LI may break down because of linguistic difficulties or because they don’t know either the script or the narrative frame. If too much mental capacity is used for linguistic processing, the narrative frame and/or the script may collapse. In similar fashion, poor script knowledge or poorly formed narrative frames may require too much mental “energy,” leaving the child little capacity for linguistic processing. Prior to collecting a narrative, an SLP should attempt to determine if a child has script and narrative frame knowledge. Script knowledge can be assessed by inquiring about a child’s experiences, routines, and event knowledge (Naremore, 2001). Assessment of the retrieval of script knowledge can be accomplished by asking a child to act out the script with toys, pictures, or other items. If the child is successful, the SLP attempts to have the child recite an event account with a cue such as “Tell me what you do when you do X” or “Tell me what happened one time when you did X.” If the child needs more help, the SLP can ask a few questions to determine the setting, then begin as follows: You ride the bus to school every day. Last week on the way to school, you . . . Note that the focus is the child and the verb tense is present. The SLP can assist the child with the event recount by saying, “And then” or “Tell me what happened next.” The recount should have some logical organization. Knowledge of narrative frames can be determined by discussing with a child the purpose of narratives and determining the child’s experience with narrative frames, either at home or in school. The SLP is interested in the use of narratives at home and in story reading. Narrative frames will be analyzed in more detail after a few narratives have been collected. Children will not possess scripts for all possible events. Nor will all children possess narrative frames. Cultural variations are to be expected and will be discussed at the end of this chapter. The SLP should be reasonably positive that the child possesses event and script knowledge and a notion of narrative frames prior to beginning a narrative collection and analysis.

Collecting Narratives The quality of a narrative is influenced by the selection of appropriate stimuli and topics based on the age, verbal ability, interests, and gender of a child or adolescent (Hedberg & Stoel-Gammon, 1986). Stimuli may include objects or pictures used for original constructions and heard or read stories used

Chapter 8

Narrative Analysis


for retelling. In general, the task used to elicit the narrative influences the speaker’s adaptation to the listener. There are many different types of stories and many different contexts within which to tell them. The story type and context affect the eventual narrative form produced (Scott, 1988b). In general, maximally naturalistic topics and contexts elicit the most representative narratives. Other variables that may affect the narrative form are the story type, a child’s experiential base, the task in which the narrative is told, the source of the narrative, the topic, the formal or informal atmosphere of the context, and the audiovisual support available (Scott, 1988b). Because the unit of analysis is the entire narrative, several oral and written narratives should be collected. The wide variation in narratives that can be produced by a single child within different contexts supports this notion. Prior to collecting, the SLP decides on the type of narratives desired and the stimuli to be used in their collection. In general, fictionalized narratives with a vicarious experiential base may result in incomplete narratives with little emphasis on goals, characters’ feelings or motivations, and endings. The pace, action orientation, and frequent commercial interruption found in television form a very different base for narratives than does experience or even traditional fables or fairy tales. The type of elicitation task will affect the child’s performance (Gibbons, Anderson, Smith, Field, & Fischer, 1986; Griffith, Ripich, & Dastoli, 1986). Books elicit descriptive information, whereas films elicit action sequences (Gibbons et al., 1986). Films also elicit more causal sequences in retelling than do oral stories. Pictures tend to constrain the form of the narrative and may lead to the production of additive chains (And this . . . and this . . .), although children with Down syndrome express more verbal content in narratives to wordless picture books than might be expected based on their formal test results (Miles & Chapman, 2002). Stories in response to pictures tend to exclude character information, internal responses, or intentions (Griffith et al., 1986). Shared information may be omitted and new information treated as old even when the listener has not viewed the picture. In contrast, individual photographs or discussions of familiar events foster event chains. Narrative retelling and recall can be used to determine a child’s memory organization (Lovett, Dennis, & Newman, 1986). In narrative retelling, the child listens to a well-formed story and then reconstructs the story orally or in writing. Retelling of short narratives even may serve as a screening tool with young elementary school children. At this age, children should be able to retell the story without deviating significantly from the original in sequence or content. In general, children with LI produce longer and more complete stories in retold narratives than in self-generated ones (Merritt & Liles, 1989). Clause length is also greater in retold narratives. Comprehension can be assessed within retold narratives by questioning a child when the original telling is complete. In general, children with LD perform much like younger children, recalling less of the stimulus story (Crais & Chapman, 1987). It is important to consider the amount of structure inherent in the stimulus and its effect on retold story construction. For example, nondescript dolls or puppets or sets of vehicles provide no structure. In contrast, a sequence of related pictures provides maximal structure. In general, the more structure found in the stimuli, the less structure the child must provide. The best stories, measured by the most complete episodes and the amount of information, occur when children retell a story without picture cues (Schneider, 1996). Although pictures provide additional input, thus reducing the memory load, they provide no linguistic structure in and of themselves. The task then becomes one of story generation rather than retelling. Pictures may distract some children with LI.


Part 2

Communication Assessment

In story retelling tasks, an SLP must consider the comprehension skills needed to understand the story, the mode of presentation (oral or written), story length, a child’s past experience with the story genre (e.g., fairy tale, mystery), the child’s interest in the content, and the degree of story structure (Hedberg & Stoel-Gammon, 1986). In general, more familiar, more interesting, and more structured stories result in more complete, better organized retellings. Well-formed stories should be chosen for retelling and should be modified to enhance clarity and organization (Gordon & Braun, 1985). Stories can be rewritten to reduce complexity in their oral form and to summarize important sections. Subparts and transitions between parts of the narrative may need to be highlighted. Good narrative models often have repetitive elements. Independent, self-generated narrative production requires a child to use her or his own organizational structure and narrative formulation. Narratives can be classified as fictional, personal-factual, or a combination of the two. Fictional or make-believe stories are good vehicles for preschoolers and may be stimulated by objects or pictures (F. Roth & Spekman, 1986; Westby, 1984, 1985). The SLP should provide a model narrative, begin the story for the child, or ask the child to relate a story about the object or picture, beginning with, “Once upon a time . . .” This initial structure usually results in a more literate style. Personal-factual narratives may be collected from conversation or prompted. This type of narrative is very common in preschool and early elementary school, especially in show-and-tell activities. Preschoolers naturally create these types of narratives in conversation with each other (Preece, 1987). An SLP should not try to elicit narratives with open-ended prompts, such as “What did you do yesterday?” It may be helpful for the SLP to establish some common experience with the child and to share a narrative about this experience as an example for the child. To get a narrative, the SLP often has to give one. Using a combination of narration and probing questions, the SLP can tell a personal story related to a common event, such as going to the doctor, and prompt the child with leading questions to stir the child’s memory of past events (“Have you ever been to the doctor?”). Experiential topics prompted in this fashion usually result in the longest and most complex narratives. Topics such as a new sibling or a death usually result in very truncated narratives. Rather the child can be prompted to relate the scariest or funniest thing that ever happened (Garnett, 1986). In addition, the child might be asked to relate a favorite movie, television show, or story, although these prompts may elicit a sequential list of events (McCabe & Rollins, 1994). The SLP should add nothing to the child’s narrative other than feedback in the form of “uh-huh,” “okay,” “yeah,” “wow,” or a repetition of the child’s previous utterance. These neutral but enthusiastic responses will not influence the course of the story as others might. The narrative can be resumed or the child prompted to continue by such utterances as, “And then what happened?” Stories are enhanced by familiarity with the listener and the location. The SLP should decide ahead of time on strategies for terminating rambling stories and for probing to elicit longer ones. A suggested guideline is not to expect children to engage in storytelling unless their MLU is 3.0 or more (Hedberg & Stoel-Gammon, 1986). Finally, the SLP will want to collect more than one from a child.

Narrative Analysis Narrative analysis is a portion of an overall language analysis occurring at both macro (overall) and micro (finite) levels. Macrostructural analysis examines hierarchical organization, such as story grammar, while microstructural considers internal linguistic structures, such as dependent clauses and con-

Chapter 8

Narrative Analysis


junctions. Macrostructural analysis can occur in several ways, such as narrative levels, high points, story grammars, and cohesive devices (Lahey & Silliman, 1987). Narrative levels are concerned with the structural relationship of the narrative parts to the narrative as a whole. Events may be seemingly unorganized or organized sequentially or by causality. Narrative levels do not have a goal-based organization, whereas story grammars (what happens in the story) do. Narrative level analysis is most appropriate for the stories of 2- to 5-year-olds (Applebee, 1978) and for school-age children with limited verbal abilities; story grammar analysis is best for those over age 5 (Glenn & Stein, 1980). The narratives of preschool children may be evaluated also by using high-point analysis to determine the type of narrative structure (McCabe & Rollins, 1994). Story grammars describe the internal structure of a story, including its components and the rules underlying the relationships of these components (Stein & Glenn, 1979). By serving as a framework, story grammars may facilitate narrative comprehension and may be used to remember and interpret stories and to anticipate content. Cohesion analysis describes the linguistic devices used to connect the elements of the text. In narratives, coherence, or making sense, is conveyed through cohesion. Inappropriate or inadequate use of cohesive devices results in a disjointed text that is difficult to comprehend. From the analysis, an SLP should address the following questions (J. Johnston, 1982): the narrative contain chains? If so, what type? • Does the narrative follow the typical story grammar model? Is the story organized maturely? • Does are the guiding scripts of the narrator, and what do they reveal about the storyteller’s knowl• What edge of events and expectations? • What linguistic means are used to create a cohesive unit? In addition, the SLP is interested in the sensitivity of the narrator to the perceived needs of the listener. NAR RATIVE LEVE LS Children use two strategies for organizing their stories: centering and chaining. Centering is the linking of attributes or objects to form a story nucleus. The links may be based on similarity or complementarity of features. Similarity links are formed by perceptually observed attributes, such as actions, characteristics, and scenes or situations. Causal links are not present, although sequential ones may be. Complementary links consist of conceptual bonds based on abstract, logical attributes, such as members of a class or events linked by cause-and-effect bonds. Chaining consists of a sequence of events that share attributes and leads directly from one to another. Most stories of 2-year-olds are organized by centering. By age 3, however, nearly half of the children use both centering and chaining. This percentage increases, and by age 5, nearly three-fourths of the children use both strategies. These organizational strategies can result in six basic developmental stages of story organization (Applebee, 1978), presented here in developmental order: Heaps are sets of unrelated statements about a central stimulus. The statements identify aspects of the stimulus or provide additional information. The common element may be the similarity of the grammatical structure, for there is no overall organizational pattern. Dogs wag their tails and bark. Dogs sleep all day. A dog chased a cat.


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Communication Assessment

Sequences include events linked on the basis of similar attributes or events that create a simple but meaningful focus for a story. The organization is additive, and sentences may be moved without altering the narrative. I ate a hamburger. And Johnny too. Mommy ate a chicken nuggets. Daddy ate a fries and coke. Primitive temporal narratives are organized around a center with complementary events. I go outside and swing. Bobby push swing. I go high and try to stop. I fall. And I start to cry. Bobby pick me up. Unfocused temporal chains lead directly from one event to another, while linking attributes, such as characters, settings, or actions, shift. This is the first level of chaining, and the links are concrete. As a result of the shifting focus, unfocused chains have no centers. The man got in his boat. He rowed and fished. He ate his sandwich. (Shift) The fishes swimmed and play. Fishes jump over the water. Fishes go to a big hole in the bottom. (Shift) There’s a dog in the boat. He’s thirsty. He jump in the water. Focused temporal or causal chains generally center on a main character who goes through a series of perceptually linked, concrete events. This boy, he found a jellybean. And his mother said not to eat it. And he did. And a tree growed out of his head. Narratives develop the center as the story progresses. Each incident complements the center, develops from the previous incident, forms a chain, and adds some new aspect to the theme. Causal relationships may be concrete or abstract and move forward toward the ending of the initial situation. While young school-age children both with LI and without use scripts for familiar events in their narratives, children with LI often omit causal links to tie together the elements of the script (Hayward, Gillam & Lien, 2007). There is usually a climax. There was a boy named Juan. And he got lost in the woods. He ate plants and trees. And he was friends with all the animals. He builded a tent to live in. One day, he builded a fire, and the policemen found him. They took Juan home to his mommy and daddy. Each narrative can be divided into episodes that are analyzed according to this scheme. Table 8.1 contains examples of narratives and their analysis by narrative level. H IG H-POI NT ANALYSIS High-point analysis is a method for identifying narrative macrostructure. The high point, or most significant point of a narrative, is revealed not in the past events recalled, but in an event’s meaning to the narrator. The accompanying structure has developmental significance. It is best for high-point analysis to use narratives that describe events in which the narrator is present (McCabe & Rollins, 1994). An SLP should select the longest personal event narratives for analysis. Length and complexity have been shown to be related (McCabe & Peterson, 1990). The narratives of some children with LI may have very poorly defined boundaries that make this demarcation difficult. The evaluated high point is marked by children in many ways. These markings include paralinguistic features, such as emphasis, elongation, and use of environmental noises (“It went BOOM!”);

Chapter 8


Narrative Analysis


Narrative-Level Analysis



Simple frames Granma lives on a farm. There are horsies and piggies. The cows moo. I can ride on the tire swing in a tree. And the calf licked me. That’s all.


Once there was two kids, Cassidy and . . . and Fred. Fred’s a funny name. And they was fighting. Their mother said, “Why are you fighting?” Cassidy and Fred doesn’t know why. They stop and be friends.

Focused chain

Complex narrative frame with episodic development The kids all went to Burger King on Halloween. Super Zhiming—that’s me—got a cheeseSequence burger. My sister got a Whopper. Mommy and Daddy got nuggets and salad bar. They were r eating when a big ghost came out of my milkshake. He threw milkshake on everyone and t Narrative got them mad. Super Zhiming stuck the ghost with a fork. The ghost got flat. All the air came out. Daddy was so happy that he buyed ice cream cones for all the kids.

and linguistic features, such as exclamations (“Wow!”), repetition, attention getters (“Here’s the best part.”), exaggeration, judgments or evaluative statements (“It was my favorite.”), emotional statements, and explanations (McCabe & Rollins, 1994). Once he or she has identified the high point of the narrative, an SLP can analyze for narrative structure. Different types of structures are presented in Table 8.2. Next to each is the age at which


High-Point Narrative Structure

Narrative Structure


Expected Age in Years

One-event narrative

Contains one event.

Below 3.5

Two-event narrative

Contains 2 past events but no logical or causal relationship in the real world or in the narrative.


Miscellaneous narrative

Contains 2 or more past events that in the real world are logically or causally related.

Very low frequency at all ages (3.5–9)

Leapfrog narrative

Contains 2 or more related past events, but the order does not mirror the real-world relationship.


Chronological narrative

Contains 2 or more related past events in a logical or causal sequence without a high point.

Present at all ages (3.5–9)

End-at-high-point narrative

Contains 2 or more related past events in a logical or causal sequence with a high point but no following events (resolution).


Classic narrative

Contains 2 or more related past events in a logical or causal sequence with both a high point and a resolution.


Source: Adapted from McCabe & Rollins (1994).


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Communication Assessment

these structures are most common for Caucasian, English-speaking, North American children. The SLP can use this table to determine whether the child is using narrative structures typical of his age group. After age 5, fewer than 10 percent of children produce one-event, two-event, leapfrog, and miscellaneous narratives. Obviously, a small sample of a few narratives will be needed for an adequate evaluation. Normal variations are to be expected within and across children. Many young children will “test the waters” by stating the high point first (“I got stung by a bee”) and then, if it is accepted, will proceed with the narrative. This is not an example of impaired narration and can be analyzed by using the suggested narrative structures when the entire narrative is told. Cultural differences must be considered too. African American children often tell topic-associating narratives in which events that happened at different times and places may be combined around a central theme. The narratives of Japanese children may be succinct collections of experiences, rather than single detailed sequential events (Minami & McCabe, 1991). Children from Latino cultures often do not relate sequential events (Rodino, Gimbert, Perez, Craddock-Willis, & McCabe, 1992). STORY G RAM MAR S Story grammars provide an organizational pattern that can aid information processing (J. Johnston, 1982b). The competent storyteller constructs the story and the flow of information in such a way as to maximize comprehension. The SLP notes the story grammar elements present in a child’s story and produces a model of the child’s story grammar (S. Chapman, 1997; F. Roth, 1986). A story consists of the setting plus the episode structure (story = setting + episode structure) (J. Johnston, 1982). Each story begins with an introduction contained in the setting, as in “Once upon a time in a far-off kingdom, there lived a prince who was very sad . . .” or “On the way to work this morning, I was crossing Main Street . . . ,” or simply “We went to the zoo today.” An episode consists of an initiating event, an internal response, a plan, an attempt, a consequence, and a reaction. An episode is considered to be complete if it contains an initiating event or response to provide a purpose, an attempt, and a direct consequence (Stein & Glenn, 1979). Episodes may be linked additively, temporally, causally, or in a mixed fashion. A story may consist of one or more interrelated episodes. The seven elements of story grammars occur in the following order (Stein & Glenn, 1979): 1. Setting statements (S) that introduce the characters and describe their habitual actions, along with the social, physical, and/or temporal contexts that introduce the protagonist. 2. Initiating events (IE) that induce the character(s) to act through some natural act (e.g., an earthquake), a notion to seek something (e.g., treasure), or the action of one of the characters (e.g., arresting someone). 3. Internal responses (IR) that describe the characters’ reactions, such as emotional responses, thoughts, or intentions, to the initiating events. Internal responses provide some motivation for the characters. 4. Internal plans (IP) that indicate the characters’ strategies for attaining their goal(s). Children rarely include this element. 5. Attempts (A) that describe the overt actions of the characters to bring about some consequence, such as attain their goal(s).

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Narrative Analysis


6. Direct consequences (DC) that describe the characters’ success or failure at attaining their goal(s) as a result of the attempt. 7. Reactions (R) that describe the characters’ emotional responses, thoughts, or actions to the outcome or preceding chain of events. The two very different stories in Table 8.3 present examples of different story grammars. There is a sequence of stages in the development of story grammars (Glenn & Stein, 1980). Certain structural patterns appear early and persist, whereas others are rather late in developing. The overall developmental sequence is as follows, although much individual variation exists: Descriptive sequences consist of descriptions of characters, surroundings, and habitual actions. There are no causal or temporal links. The entire story consists of setting statements. This is a story about my rabbit. He lives in a cage. He likes to hop around my yard. He eats carrots and grass. The end. Action sequences have a chronological order for actions but no causal relations. The story consists of a setting statement and various action attempts. I had a birthday party. (S) We played games and winned prizes. (A) I opened presents. (A) I got balloons. (A) I blowed out the candles. (A) We ate cake and ice cream. (A) We had fun.


Story Grammar Examples


Story Grammar Elements

I. Single Episode There was this girl, and she got kidnapped by these pirates. So when they were eating, she cut the ropes and got away. And she lived on a island and ate parrots.

Setting statement (S) Initiating event (IE) Attempt (A) Direct consequence (DC) Reactions (R)

II. Multiple Episodes Once there was this big dog on a farm. And he got hungry ’cause there wasn’t enough food. The dog . . . his name was Max . . . was sad with no food, so his owner went to find some. He met a witch, but she wouldn’t give him food ’til he killed a yukky toad. He was scared but he decided to build a trap. He dug a hole and filled it with frog food. The frog wanted to eat the man but got caught. The man went back to the witch and she got some hamburgers for the man and the dog. And the man and Max ate hamburgers and were happy.

Setting statements (S) Initiating event1 (IE1) Internal response1 (IR1) Attempt1(A1) Initiating event2 (IE2) Internal response2 (IR2) Internal plan2(IP2) Attempt2(A2) Direct consequences2 (DC2) Direct consequence1 (DC1)

Reaction1 (R1)


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Communication Assessment

Reaction sequences consist of a series of events in which changes cause other changes, with no goaldirected behaviors. The sequence consists of a setting, an initiating event, and action attempts. There was a lady petting her cow. (S) And the cow kicked the light. (IE) Then the police came. (A) Then a fire truck came. (A) Then a hook-and-ladder came. (A) And that’s the end. (S) Abbreviated episodes contain an implicit or explicit goal. At this level, the story may contain either an event statement and a consequence or an internal response and a consequence. Although the characters’ behavior is purposeful, it is usually not premeditated. There was a mommy and two kids. (S) And the kids baked a cake for the mommy’s birthday. (S) They forgot to turn on . . . off the stove and burned the cake. (IE) The kids went to the store and buyed a cake. (C) The end. (S) Complete episodes contain an entire goal-oriented behavioral sequence consisting of a consequence statement and two of the following: initiating event, internal response, and attempt. This man was a doctor. (S) He made a monster. (IE) And it chase him around his house. (IE) He run in his bedroom. (A) He push the monster in the closet. (A) And the monster go away. (C) That’s all. (S) Complex episodes are expansions of the complete episode or contain multiple episodes. Once there was this Luke Skywalker. (S) And he had to fight Darf Invader. (S/IE) They fought with swords. (A) And he killed him. (C) And he got in his rocket to blow up these kind of horse robots. (IE) And he shot them. (A) Then all the bad soldiers were killed. (C) Interactive episodes contain two characters who have separate goals and actions that influence each other’s behavior. Sally never helped her mom with the dishes. (S) She got mad and said that Sally had to do it. (IE) So, Sally washed the dishes but she was mad. (IR) Then Sally dropped some dishes. (A) Then she dropped more. (A) And her mom said that she didn’t have to do any more dishes. (C) And Sally watched TV every night after dinner. (S) Specific structural properties associated with each structural pattern are listed in Table 8.4. Children with LD produce fewer mature episodes than do their age-matched TD peers. In addition, children with LD make fewer complete setting statements and are less likely to include response, attempt, and plan statements in their narratives (F. Roth & Spekman, 1986). Inter-episodic relations are also weaker in the narratives of children with LD. Story grammar analysis alone may lack the sensitivity to differentiate children with LI from those without (Hewitt & Duchan, 1995; Merritt & Liles, 1987; Ripich & Griffith, 1988). The portrayal of subjective states—think, remember, feel, know—as in the internal response element of story grammars is especially difficult for children with LI and may be central to narratives (Astington, 1990). Unfortunately, there are few normative data for clinical use. In general, children developing typically produce all of the elements of story grammar by age 10. Children’s narratives can be used, however, to approximate their functioning level and to determine which structural elements are present (Hedberg & Stoel-Gammon, 1986). Table 8.5 on page 228 contains several narratives analyzed by story grammar structural pattern and narrative level.

Chapter 8


Narrative Analysis


Structural Properties of Narratives

Structural Patterns

Structural Properties

Structural Patterns

Structural Properties

Descriptive sequence

Setting statements (S)(S)(S)

Complex episode

Action sequence

Setting statement (S) Attempts (A)(A)(A)

Reaction sequence

Setting statement (S) Initiating event (IE) Attempts (A)(A)(A)

Abbreviated episode

Setting statement (S) Initiating event (IE) or Internal response (IR) Direct consequence (DC)

Complete episode

Setting statement (S) Two of the following: Initiating event (IE) Internal response (IR) Attempt (A) Direct consequence (DC)

Multiple episodes Setting statement (S) Two of the following: Initiating event (IE1) Internal response (IR1) Attempt (A1) Direct consequence (DC1) Two of the following: Initiating event (IE2) Internal response (IR2) Attempt (A2) Direct consequence (DC2) Expanded complete episode Setting statement (S) Initiating event (IE) Internal response (IR) Internal plan (IP) Attempt (A) Direct consequence (DC) Reaction (R)

Interactive episode

Two separate but parallel episodes that influence each other

EXPR ESSIVE E LAB ORATION Expressive elaboration occurs when the storyteller goes beyond information transmission and creates a pattern of theme, structure, story genre, and mood. The result is an interesting or well-crafted narrative. The skilled narrator selects words and sentence structure to attain his or her desired affect on the listener. For example, the narrator might withhold certain information in order to build suspense or choose words that create a specific illusion. Even real-life narratives may include fictionalized elements that increase listener interest. Three types of expressive elaboration may be evaluated: appendages, orientation, and evaluation (Ukrainetz, Justice, Kaderavek, Eisenberg, Gillam, et al., 2005). Appendages alert the listener that a story is being told or ended and consist of five categories: or opening elements (One morning last week . . .). • Introducer Abstracts, which • when I . . .). provide summaries of events prior to the narrative (This is about what happened which provide summaries within the narrative (This is why I’m so grouchy today) • Themes, Codas, which are general observations that show the effect on the narrator or characters (So I • learned not to drive too fast). Enders (The end). •


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Communication Assessment

Story Grammar Analysis


Story Grammar Elements

I. We went to a farm. I got to feed chickens. Then I saw cows in the barn. Cows give milk. Cows stay in the field all day and eat grass. At night they come in.

(S) (S) (S) (S) (S) (S)

II. There was this boy who lived in a city. And one day a giant bug got out of this place where they keep bugs. And the boy got in an airplane and shot it. III. Once there was two boys. One boy fell into a big hole with rats and he was scared. His brother got a ladder but the rats ate it. So, he threw his lunch in the hole. The rats ate it, too, and the boy climbed up a rope and was safe.

(S) (IE)

Structural Pattern

Narrative Level


Descriptive sequence

Unfocused temporal chain


Reaction sequence

Focused temporal chain


Complex episodes


(A) (S) (IE1) (IR1) (A1) (DC1/IE2) (A2) (DC2) (R)

Note: Even though the third narrative possesses advanced structural properties, it demonstrates some pronoun confusion. The relationship of the boys is not established until the third utterance.

Orientations are setting statements and consist of three categories: (Jill). • Names Relations, describe roles or jobs (my teacher). • Personalitywhich attributes that persist throughout the narrative (lazy). • Finally, evaluation describes how the narrative and character perspectives are delivered. Evaluation consists of five categories: modifiers, which consist of most descriptive adjectives and adverbs. • Interesting Expressions, are multiword modifiers (tired as a marathon runner). • Repetition ofwhich nouns, or verbs (walked and walked and walked) for effect. • Internal state words,adjectives, which reflect thoughts (remembered), feelings (depressed), reactions • (surprised), intentions, and physical states (tired). Dialogue (So she said . . .). • By age 9, all typically developing children should exhibit some expressive elaboration in their narratives. Naturally, these vary by type of elaboration, so several narratives are required for a full picture of a child’s abilities. Table 8.6 presents narratives with varying types of expressive elaboration.

Chapter 8


Narrative Analysis


Types of Elaboration Found in Narratives by Age 9

Evaluations—Most frequent; increase with age Modifiers

Adjective, adverbs, and adverbial phrases*

mighty, angry, shy, slowly, in between


Multiword modifiers

as quietly as she could, wrong side of the tracks, all of a sudden


Repetition of a word for emphasis

He ran and ran to get way, They were very, very happy

Internal States

Words reflect intentions, thoughts, feelings, emotions, motivations, and reactions

thought, sad, angry, tired, decided, planned


Portions of narrative in which characters speak

She shouted, “Stop that!”

Orientations—Increase with age Names

Characters identified specifically on first mention

King Juan, Jack, Monica


Relationships of jobs defined

Monica’s sister, teacher, pet


Personal attributes that endure throughout the story

always late, too young to, grumpy old woman

Appendages—Least frequent; increase with age Introducer

Beginning of narrative marked

Once upon a time, One night, Yesterday


Summary prior to narrative or story title

This is a story about why you you shouldn’t run away, This is called “My Best Day”


Summary within narrative

And this is why he was so scared


Effect of narrative or lesson learned

So they decided never to ride their bikes in the woods again


Formal indication narrative is over

That’s it, The end, And they lived happily . . .

*Some occur so frequently that they should not be noted. These include some, other, another, one, little, big, bad, on top, outside, behind, and after. Source: Compiled from Ukrainetz, Justice, Kaderavek, Eisenberg, Gillam, & Harm (2005).

QUANTITATIVE M EASU R ES Several microstructural measures vary significantly with age. These are total number of words (TNW), number of different words (NDW), total number of T-units (LENGTH), mean length of T-units in words (MLT-W), total number of T-units that contain two or more clauses (COMPLEX), and the proportion of complex T-units (PROCOMPLEX) (Justice, Bowles, Kaderavek, Ukrainetz, Eisenberg, et al., 2006). These values are presented in Table 8.7. Be cautioned that these data are from a pilot study, albeit a well-done one, and that there is wide variability among TD children, as seen in the standard deviation (SD). Within one standard deviation is where the normal population is considered to be. Episodic structure and syntactic accuracy are good measures of language in children from CLD backgrounds (Muñoz et al., 2003). More semantically based quantitative measures, such as the number of different words, seem to vary with the method of elicitation (Uccelli & Páez, 2007).


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Communication Assessment


Narrative Microstructure










(± 47)


(± 20)


(± 5.4)



(± 54)


(± 22)


(± 6)







6.8 (± 1.7)


(± 3.2)


(± .2)


(± 1.6)


(± 2.8)


(± .2)



(± 74)


(± 28)


(± 9.1)

8.5 (± 3.8)


(± 4.3)


(± .2)



(± 77)


(± 27)


(± 8.9)

8.1 (± 1.4)


(± 5.2)


(± .2)



(± 96)


(± 30)


(± 9.6)

8.4 (± 1.4)


(± 6.1)


(± .2)



(± 196)


(± 49)


(± 14.5)

8.9 (± 2.1)


(± 9.8)


(± .2)

Note: Columns include total number of words (TNW), number of different words (NDW), total number of T-units (LENGTH), mean length of T-units in words (MLT-W), total number of T-units that contain two or more clauses (COMPLEX), and the proportion of complex T-units (PROCOMPLEX). Source: Adapted from Justice, Bowles, Kaderavek, Ukrainetz, Eisenberg, & Gillam (2006).

COH ESIVE DEVICES Children with LI and those with poor reading abilities exhibit some difficulty communicating wellorganized, coherent narratives (Norris & Bruning, 1988). In general, they produce event and essential relationships more poorly than do their age-matched TD peers (J. Johnston, 1982; Liles, 1985a, 1985b, 1990; Merritt & Liles, 1985). The most common cohesive errors among children with LI are an incomplete tie, in which the child references an entity or event not introduced previously, and an ambiguous reference, in which the child does not identify to which of two or more referents she or he is referring (Liles, 1990). Of interest in the text are cohesive devices that linguistically connect the components. In short, any sentence element that sends the listener outside of the sentence for a referent is a cohesive device. For example, a pronoun may require referral to the previous sentence in order to determine the referent. The five types of cohesive relations are reference, substitution, ellipsis, conjunction, and lexical items. Of these, lexical cohesion may be the most difficult to assess reliably (Liles, 1990). Because there is little normative data on the development of these relations, descriptive analysis is the best diagnostic approach. In general, mature story grammar develops prior to mature use of cohesive devices. It is possible, therefore, to have good episodes but poor cohesion. The two are related but not dependent. The cohesion within and between episodes becomes important as children develop complex and interactive episodes. There is a metalinguistic quality about cohesion in that the speaker must pay attention to the text apart from the story itself. Cohesive relations are discussed in Chapter 6 and are reviewed only briefly in this section. Cohesion repairs require particular organizational strategies not found in conversation. Older children, aged 8.5 to 12.5, most often make meaning repairs in narratives and in conversation, recognizing the importance of being comprehended successfully (MacLachlan & Chapman, 1988; Purcell & Liles, 1992). Cohesion repairs are made frequently by both children developing typically and those with LI, but with different levels of success (Purcell & Liles, 1992). In general, both types of children are equally successful with repairs within T-units, usually consisting of single-word repair. In repairs across T-units, requiring reorganization of several sentences, however, children with LI are less success-

Chapter 8

Narrative Analysis


ful. This difference may reflect underlying language skills and processes (Butler, 1986; L. Miller, 1984; Van Kleeck, 1984; Wallach & Liebergott, 1984). Reference Reference devices, which refer to something else in the text for their interpretation, consist of pronouns, definite articles, demonstratives, (this, that) and comparatives (bigger shown). The link with the referent should be clear and unambiguous. Clarity is often a problem when a child changes the story narrator frequently, uses dialogue, or includes several characters. Pronouns and definite articles are used to refer to referents previously identified in the narrative. Narrative analysis, especially semantic elaboration and pragmatic inappropriateness, appears to be an appropriate way to assess the language differences of children, especially those with FASD (Thorne, Coggins, Carmichael Olson, & Astley 2007). Semantic elaboration is measured by the use of nouns and pronouns to reduce ambiguity in the narrative, the specificity of the nouns and verbs used to introduce an entity (thing vs. hammer) or action (went vs. drove), and noun and verb elaborators (large angry dog and ran quickly, respectively). The Semantic Elaboration Coding System (Thorne, 2004) offers a convenient way to analyze this data. In contrast, demonstratives locate referents on a continuum of proximity. Nominals, such as this, that, these, and those, refer to a person or a thing; adverbs, such as here, there, now, and then, refer to a place or a time. Use of now and then usually is restricted to referring to the time just mentioned. In addition, now and then can serve as conjunctions. Finally, comparatives are both general, referring to similarities and differences without reference to a particular property, and specific, referring to some specific quantity or quality. General comparatives include such words as another, same, different(ly), equal(ly), unequal, identical, similar(ly), and else. Specific quantity words include more, less, so many, as few as, second, further, and fewer than. Quality words and terms consist of worse than, as good as, equally bad, better, better than, happier than, and most happy/happiest. Substitution and Ellipsis Substitution and ellipsis both refer to information within the narrative that supposedly is shared by the listener and the speaker. In substitution, another word is used in place of the shared information. The words one(s) and same can be substituted for nouns, as in “Make mine the same” or “I’ll take one, too.” Such words as do can be substituted for main verbs, as when we emphasize,“I did already.” Finally, such words as that, so, and not can be substituted for whole phrases or clauses, as in “I think not” or “Mother won’t like that.” Ellipsis differs from substitution in that shared information simply is omitted. Whole phrases and clauses may experience ellipsis. Any portion of the noun phrase may be omitted, as in the following examples: I have four of her brightly wrapped red gifts. Which is yours? Would you like two? Do you have green? Verbal material also may be omitted, as in the response “He can’t” to the question “Will John attend the concert tonight?” Clausal ellipsis may be demonstrated with the same question when the answer is “Probably.”


Part 2

Communication Assessment

Conjunction The four types of conjunctive relations are additive, temporal, causal, and adversative. Whereas additive relationships usually are represented by and, temporal ones may be signaled with a variety of words, such as then, next, after, before, at the same time, finally, first, second, and an hour later. Causal conjunctive relationships may be expressed with a variety of terms, such as because, as a result of, in that case, for, and so. Finally, adversative conjunctions include but and others, such as however, although, on the other hand, on the contrary, except, and nevertheless. Conjunction use may be independent of the specific clausal structures linked. In other words, conjunctions link the underlying semantic concepts and thus represent the relationship of these units, which may be expressed by various syntactic units. The way episode parts are linked may reflect a child’s underlying episodic organization. We would expect, therefore, that conjunctive relationships between episodic elements would be more complex and difficult than those between sentences. This increase seems to be true for both children with LI and those without (Liles, 1987). This may account for the fewer conjunctions found in the narratives of children with LI (Greenhalgh & Strong, 2001). Lexical Items Words themselves express relationships by the morphological endings used. For example, the present progressive -ing ending is used to express actions taking place at the present time. The following example demonstrates a clear understanding of the relationship of the process to the product: He had been writing for several months. After the book was finally written, he celebrated for days. He swore never to write another novel. Categorical relationships can be expressed and demonstrate convergent and divergent organizational patterns. Convergent thought goes from the members to the category, as in “She had petunias, dahlias, roses, and pansies in her garden, but she could never have enough flowers.” Divergent thought goes from the category to the members, as in “She liked several kinds of sports but was best at soccer, rugby, and lacrosse.” Finally, words can express relationships, such as opposition or part-to-whole. In a narrative, the SLP can look for antonyms, synonyms, ordered series, and part-whole or part-part relationships. Ordered series include memorized sequences, such as the days of the week, or hierarchies, such as instructor, assistant professor, associate professor, and full professor. Part-whole relationships are expressed by entities that form a portion of the whole, as in rudder-boat, pedal-bike, and Januaryyear. Finally, part-part relations contain parts of the same whole, as in nose-chin, finger-thumb, and rudder-sail. Conclusion Narratives require the manipulation of extended units of language. Cohesive devices are indirectly assessed by certain quantitative measures. R E LIAB I LITY AN D VALI DITY Narrative analysis is not without its detractors. The reliability and validity of narrative analysis as a clinical tool has been questioned (Klecan-Aker & Carrow-Woolfolk, 1987). Naturally, reliability and validity will vary with the aspects of narratives measured.

Chapter 8

Narrative Analysis


Establishing developmental level by the number of story grammar components present appears to have very high inter- and intrajudge reliability (Klecan-Aker & Hamburg, 1991; Klecan-Aker, Swank, & Johnson, 1991). This developmental level and other quantitative measures, such as words per T-unit and words per clause, also correlate strongly with language test scores, suggesting that narrative analysis has strong construct validity.

Children with CLD Backgrounds Children entering school with good narrative abilities are better prepared to comprehend and produce the decontextualized language of reading and writing (Gee, 1989; Westby, 1984). Other children are at greater risk of academic failure (Orum, 1986; U.S. Bureau of the Census, 1990). To tell, retell, or comprehend the literate narratives found in English, a child must have a concept of story grammar and a cultural script for the story. Narrative performance among various cultural, ethnic, and linguistic groups may differ greatly. These differences reflect both cultural and individual differences in storytelling. Storytelling is never context or culture free (Gutierrez-Clellan & Quinn, 1993). Rather, it is the product of the contextual interaction of the narrator and the audience and of the sociocultural norms of each, which shape each person’s presuppositions and expectations. Even the purpose and context for narratives varies across cultures. Telling narratives is a social event governed by cultural norms and values. Not every culture expects the narrative monologues seen in American English. Among some Latinos, Native Americans, African Americans, Jewish Americans, and Hawaiian Americans, stories are produced conversationally with audience cooperation. The story is built by the storyteller acting out the parts as the audience challenges and contradicts. Narrative completeness will reflect also each child’s experience and world knowledge (Ross & Berg, 1990). Pictures and topics that are used to elicit a child’s narrative may be beyond the child’s experiential base and result in diminished performance. It is difficult for children to tell stories with unfamiliar scripts. A child unfamiliar with a farm, for example, may use the word truck for tractor and garage for barn. Even the temporal qualities of narratives reflect the temporal realities of different cultures. The importance of seconds, minutes, and hours in Western culture is not found in others. A good friend once told me of his grandfather, a Cherokee elder, who measured time by the slow, purposeful movement of the earth and moon. A Bolivian American friend laughingly confided that her parents usually arrived at a wedding in time to throw the rice. Narratives in Standard American English dialects tend to be linear and temporal-causal. This is not true of all dialectal speakers. The narratives of Athabaskans, a native Alaskan people, are spatially or circularly organized (Silliman, Diehl, Aurillo, Wilkinson, & Hammargren, 1995). Many Native American narratives stress community, harmony, and tribe rather than individual actions to overcome some challenge (Westby & Roman, 1995). Although the narratives of speakers of African American English are linear, they meander more than those of majority speakers and, thus, are longer, with more shifts of time, place, and characters. Many of the aspects of narrative analysis discussed previously are based on American English forms and cultural expectations, such as the narrative organization and the use of linguistic devices. The analysis in this chapter assumes that all narratives are composed of an elaborated story grammar. Episodic structure and content vary with culture (Kay-Raining Bird & Vetter, 1994). The


Part 2

Communication Assessment

narratives of the Athabaskan people characteristically include four actors, four major instruments of action, and four sections: introduction, scene 1, scene 2, and closing (Silliman et al., 1995). In contrast, the narratives of Japanese children are very sparse, consisting of two-unit episodes: a challenge and a consequence. Likewise, the narratives of African American children have fewer formal beginnings and endings and less chronology while containing more judgments on characters and their actions (Heath, 1983). In addition, the stories of African American and Puerto Rican children embed such evaluations within the narrative and are less likely than European American children to state the point of the story explicitly at the end (Iglesias, Gutierrez-Clellan, & Marcano, 1986). Grammatical contrasts offer further examples. In Spanish, referential cohesion is demonstrated in the introduction of and the later referral to different entities in the story. Characters, props, and places may be referenced by the nominal (un nene/a boy), elliptical (El fue a la tienda, cogio un poco de comida/He went to the store, got some food) (Gutierrez-Clellan & Heinrichs-Ramos, 1993, p. 560), or the demonstrative (este/this). In addition, both characters and props may be referenced by the pronominal (elle/she). With increasing age, Spanish-speaking and English-speaking children use ellipsis more for place (Gutierrez-Clellan & Heinrichs-Ramos, 1993). Once the setting has been introduced, it is not named again unless changed. Whereas the use of ellipsis in English requires previous reference, speakers of Spanish may omit referential information because verb endings mark this information (tuvo/I had; tuviste/you had). Children speaking Spanish who are familiar with this practice may omit nominal reference in English too, giving the impression that they do not understand cohesion. Still, there is much similarity in narrative development. By age 4, children speaking Spanish have a wide range of referential strategies. The nominal and elliptical forms are used for characters in the subject position, while pronominals are used for those in the object (Gutierrez-Clellan & HeinrichsRamos, 1993). As children speaking Spanish get older, a greater number of props and places are introduced, and their narratives become more detailed, though not necessarily much longer (Gutierrez-Clellan & McGrath, 1991). More and more information is embedded, decreasing the number of sentences needed to express the same information. Redundant information is omitted. The number of characters changes little, however, from ages 4.5 to 8 years. Children speaking Spanish develop causal sequences at about the same age as children speaking American English. From ages 4 to 9, there is a decrease in two-clause causal sequences and in the proportion of unrelated statements and an increase in three-clause causal sequences (Gutierrez-Clellan & Iglesias, 1992). Action sequences predominate as a means of moving the story forward. Physical and emotional states as the cause of change tend to remain stable from ages 4 to 9. Other devices, such as paralinguistics, may be used by other cultures more than by the majority American culture, which tends to rely on rising and falling intonation (Gee, 1986; Michaels, 1986). For example, African American and Puerto Rican children use more loudness, pitch, rate, stress, rhythm, and intonation along with exclamations and repetitions than do majority children to move the story forward and to make evaluative or emotional comments (Iglesias et al., 1986). In other cultures, false starts and hesitations function as internal organizers, while slower pace through repetition, redundancy, and silence may signal the point of the story or its conclusion (Gee, 1986, 1989).

Chapter 8

Narrative Analysis


Narrative Collection and Analysis The cultural variability of narratives requires an SLP to assess narrative development in a wide variety of culturally relevant contexts approaching the natural environment of the child (Gutierrez-Clellan & Quinn, 1993). If the child does not consider the task “worthy,” he or she may give less than an optimum or even typical performance (Iglesias et al., 1986). The SLP may err on the overly cautious side by assuming that all differences are cultural or that the child can only produce narratives of a familiar type in familiar contexts. A third option, discussed previously, is a dynamic assessment that evaluates the child’s learning potential or teachability (Feuerstein, Rand, Jensen, Kaniel, & Tzuriel, 1987). A dynamic assessment of narrations consists of a collection and analysis, mediated instruction, and a second collection and analysis (Gutierrez-Clellan, Peña, & Quinn, 1995; Gutierrez-Clellan & Quinn, 1993; Peña, 2002). With school-age children, the SLP first can collect narratives in response to wordless picture books and analyzes each for the number of words, C-units, clauses, clauses/C-unit, episodic structure, story components, and story idea and language. Possible wordless picture books include Bird and His Ring (Miller, 1999b), Frog, Where Are You? (Mayer, 1969), One Frog Too Many (Mayer & Mayer, 1975), and Two Friends (Miller, 1999a). In the second step, the SLP can choose one or two areas of the narrative for a mediated language experience (MLE). The SLP helps the child explore the goals of a story, the importance of these goals, the consequences of omitting these goals, plans for using this information, and developing strategies. The second collection and analysis is similar to the first but attempts to answer five questions (Peña, 2002): Was the child able to form a more complete and coherent narrative? How difficult was it for the SLP to achieve positive change? Did the child pay attention and include more elements in the second narrative? Was the child able to transfer the learning without SLP support? Was learning quick and efficient? Children developing typically usually make rapid changes and are very responsive. For more-mature children and adolescents, several narratives can be collected in various contexts and analyzed as above and for the “rules” appropriate for each type of narration. The characteristics of each type of narration based on temporal, referential, causal, and spatial coherence are included in Table 8.8 (Gutierrez-Clellan & Quinn, 1993). The SLP must remember that the “rules” for certain types of narration may be unfamiliar to some children and may be a difference, rather than a deficit. The types of cohesion used by the child should reveal his or her narrative style. In the second step, the different types of narratives are explained to the child by using cues, such as “Talk like a book in school” or “Talk like you would to a friend,” and examples. Within the training, the child is given different types of narratives to produce. Feedback is used by the SLP to seek clarification, additional information, relevant comments, and reference. After some intervention, the SLP attempts to determine whether the child can learn different types of narration, can transfer the types of cohesion across contexts, and can tell narratives without cuing and feedback.


Part 2


Communication Assessment

Types of Narration and Cohesion

Temporal Coherence Is there a temporal order of events? Are temporal connectives necessary? If so, are they used? Are shifts in time marked? Causal Coherence Are physical and mental states used to interconnect actions? (He was very tired, so he went to sleep.) If not, can connectives be inferred easily? Are causal connectives necessary? If so, are they used? Referential Coherence Participants Is adequate reference to the participants made? Are new characters introduced clearly? If not, are they referred to as if introduced elsewhere in the text? Are characters reintroduced in an unambiguous manner? Can the referent be inferred from general world knowledge? Props Is identification of specific objects necessary? If so, are props mentioned adequately? If not, are props introduced by gestures or deictics, such as “that thing”? Can the identity of props be inferred from descriptions or functions? Spatial Coherence Is information about location necessary? If so, are locations identified? Are shifts in location clearly marked? Source: Adapted from Gutierrez-Clellan & Quinn (1993).

Two measures that seem particularly important are the length of causal sequences and the number of unrelated statements. Among children speaking Spanish, an increase in the length of causal sequences and a decrease in the number of unrelated statements are indicators of greater causal cohesion (Gutierrez-Clellan & Iglesias, 1992). Dynamic procedures work well with children from different sociocultural backgrounds (Lidz, 1987; Peña & Iglesias, 1989; Sewell, 1987). The procedures require that the task be explained, that the reasons for certain responses be stated adequately, and that the child respond differentially to the SLP’s cues (Gutierrez-Clellan & Quinn, 1993).

Conclusion The near universal use of some form of narrative suggests its importance in communication. As in dialogue analysis, it is important to analyze narratives simultaneously at several levels. Although there are few normative data on narrative development against which to compare a child’s or adolescent’s performance in any culture, an SLP can use the model described in this chapter as a basis for analysis and description of a child’s narrative performance. In general, the more mature the narrative, the more complete the structure and the story grammar. In addition to causal chains, more-mature narratives contain greater cohesion to aid the listener

Chapter 8

Narrative Analysis


in interpretation. Mature narratives are structurally cohesive and proceed from one event to another in a logical fashion that demonstrates the narrator’s attempt to guide the listener. More-mature narratives also include more insight into the thoughts and feelings of the central characters and greater use of devices for expressing time and place. There are fewer extraneous details and loose ends. An SLP should be cautious when evaluating children from cultures whose narratives do not closely follow the pattern described in this chapter. Children from some Spanish-speaking and some Native American cultures may have less experience with story narratives. To varying degrees, these cultures make extensive use of more descriptive narratives. The use of pictures and elicitation techniques, such as “Tell me a story about this picture,” may evoke a very different narrative from what is sought.

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3 part



A Functional Intervention Model C H A PTE R 10

Manipulating Context C H A PTE R 11

Specific Intervention Techniques C H A PTE R 12

Classroom Functional Intervention C H A PTE R 13

Literacy Impairments: Language in a Visual Mode

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A Functional Intervention Model


Part 3 Intervention


raditional language intervention does not consider either the integrated nature of language or the context of language use (Duchan, 1997). Language is viewed as a hierarchically organized set of rules, rather than as a holistic set of variable context-sensitive rules (Rice, 1986). Although the focus may include form, content, and use, the overall design is usually additive, rather than integrative. Often, the stated goal is to learn specific language units, not enhance communication. Language methods that emphasize very specific skills seem to have very specific, limited effects. There is little evidence that newly acquired forms will generalize to everyday conversational use (Olswang & Bain, 1991). Clinical intervention should be a well-integrated whole in which the various aspects of language combine to enhance communication. The purposes of intervention should be (a) to teach a generative repertoire of linguistic features that can be used to communicate in socially appropriate ways in various contexts and (b) to stimulate overall language development (Duchan, 1997; Russell, 1993; Warren & Kaiser, 1986a). A functional language intervention model attempts to target language features that a child uses in the everyday context, such as the home or the classroom, and to adapt that context so that it facilitates the learning of language. Table 9.1 presents a comparison of the traditional language intervention model with a functional integrated approach. The functional approach recognizes a need to orient language training toward the inclusion of family members and teachers as language facilitators and toward the use of everyday activities for encouraging functional communication. Therefore, routines within the home, school, and community are used with an array of language facilitators. In this way, aspects of language can be trained as they relate to one another within the context of a meaningful experience. As a result, the intervention experience more closely approximates patterns of nonimpaired language development. Content is based on common experiences. This functional approach, with its integrative and interactive aspects, changes the nature of the clinical interaction and the role of the SLP. The SLP becomes a consultant for the other language facilitators, who interact more frequently with the child, training them to modify the contexts within which language can occur and to elicit and modify the child’s language. The SLP and caregivers collaborate in the child’s language intervention. Concern for generalization is foremost and governs the overall intervention approach. Planning by an SLP, along with the language facilitators, is essential. Implementation and generalization may be hampered or impeded by any number of factors, such as the targets selected, the intervention setting, the training methods used, and caseload and scheduling considerations. Intervention should begin with a generalization plan (Stremel-Campbell & Campbell, 1985) that identifies features of a child’s communication environment relevant to generalization. All too often, generalization is the last step in the intervention planning process, rather than the overall organizing aspect. Once the appropriate generalization variables have been identified, an SLP can begin to design intervention strategies. The relevant features of the communication environment that have been identified can now be enlisted. Ideally, such intervention enables an SLP to (a) develop linguistic constructs at a child’s developmental functioning level, taking into account the strategies children normally use when acquiring language, (b) integrate all linguistic areas within the communication framework, and (c) provide meaningful and age-appropriate contexts (Gullo & Gullo, 1984). In this chapter we discuss principles of intervention in a functional approach and an overall model for intervention, focusing on the variables that affect generalization.

Chapter 9


A Functional Intervention Model


Comparison of Traditional and Functional Intervention Models

Traditional Model

Functional Model

Individual or small group setting using artificial situations.

Individual or small or large group setting within contextually appropriate setting.

Isolated linguistic constructs with little attention to the interrelationship of linguistic skills.

Relationship of aspects of communication stressed through spontaneous conversational paradigm.

Intervention stresses modeling imitation, practice, and drill.

Conversational techniques stress message transmission and communication.

Little attention to the use of language as a social tool during intervention sessions.

The use of language to communicate is optimized during intervention sessions.

Little chance or opportunity to develop linguistic constructs not targeted for intervention.

Increased opportunity to develop a wide range of language structures and communication skills through spontaneous conversation and social interaction.

Little opportunity to interact verbally with others during intervention.

Increased opportunity to develop communication skills by interacting with a wide variety of partners.

Source: Adapted from Gullo & Gullo (1984).

Principles Use of a functional approach to language intervention requires an SLP to change some methods and to be mindful of certain principles that aid communication with and learning for a child. It is important to engage a child in meaningful dialogue or in some other communication event, and this event becomes the vehicle for learning and generalization. The following section includes some of the most important principles of the functional approach. Undoubtedly, some important ones have been omitted that the reader will want to include in her or his repertoire. TH E LANG UAG E FACI LITATOR AS R E I N FORCE R As communicators, we continue to interact with those individuals who provide positive feedback and reinforcement. Each of us avoids communicating with certain individuals who are nonresponsive, caustic, or overly critical. Children avoid certain potential conversational partners for many of the same reasons. If SLPs want children to communicate with them, then they must be people with whom children want to communicate. Children respond most readily to adults who convey genuine caring and respect for them. These attitudes are conveyed by meeting a child halfway. Adults who desire to be effective conversational partners must appreciate the world from a child’s perspective. Events easily understood by an adult may be quite incomprehensible to a young child. It may help to recall that for children the world is full of wonder and delight, full of things that cannot be explained, and full of magic. Adults demonstrate concern for children and adolescents when they are willing to attend to children, to listen, and to accept their topics. As much as possible, intervention should be nonintrusive, with


Part 3 Intervention

facilitators providing supportive, evaluative feedback to a child. By reducing the authority-figure persona, demonstrating an attentiveness and a willingness to adopt a child’s topics, and remaining accepting while providing evaluative feedback, an SLP can send a message of acceptance of the child as a partner. Few child linguistic responses are totally wrong. Even seemingly incorrect utterances demonstrate the child’s understanding of the situation and of the underlying relationships. Acceptance of a child includes acceptance of these utterances. Usually, some portion of the utterance can be reinforced. Child: I need ear-gloves. SLP: That’s right, they are like little gloves for your ears. We call them earmuffs. Here, let me help you put on your earmuffs. The partner has accepted the child’s utterance, recognized the child’s understanding of the situation, corrected the utterance, and left the child’s ego intact. The intervention setting itself should “create and sustain an atmosphere containing fun, surprise, interest, ease, invitation, laughter, and spontaneity” (Cochrane, 1983, p. 160). In such an atmosphere, children will be eager to participate. One of my best lessons on verbal sequencing used mime, complete with whiteface. The children enacted familiar everyday event sequences, such as making breakfast, while other students tried to guess the name of the sequence. After the correct guess was given, the actor stated each event in the sequence while performing it. Finally, each actor attempted to reconstruct the sequence verbally. The lesson was messy, fun, enjoyable, and thoroughly successful. Children also respond favorably if the facilitator occasionally plays the clown or buffoon. I may wear a cooking pot on my head in order to evoke a response. On other occasions, I purposely may make incorrect verbalizations or actions. I’ve even dressed as a chicken. These behaviors add to the magic of the communication situation and encourage children to communicate in an accepting atmosphere. CLOSE APPROXI MATION OF NATU RAL LEAR N I NG Language intervention strategies should approximate closely the natural process of language acquisition. The strategy should be communicative in nature and should use language as it naturally occurs (Mahoney & Weller, 1980). Teaching language devoid of its communicative function deprives a child of intrinsic motivation and of one essential element of generalization. Natural language models—parents, teachers, aides, and others—should be the principal resources for implementation of language intervention (Broen & Westman, 1990; Crais, 1991, 1992; Hazel, 1990; Whitehurst et al., 1991). These individuals serve as language models with or without the SLP’s input. Their potential as language facilitators can be exploited best, however, when they are guided in content selection and trained in facilitative techniques. When using these language facilitators within the child’s everyday situations, the role of the SLP changes to that of collaborator. FOLLOWI NG DEVE LOPM E NTAL G U I DE LI N ES The language development of typical children can guide the selection of training targets. As a group, these children develop language in a similar, albeit individualistic, manner. Generally, language form is preceded by function, with easier, less complex structures being learned first. Children use the language they possess to accomplish their language goals. These uses are the framework within which new forms develop. The overall result is a hierarchy that suggests steps for training language.

Chapter 9

A Functional Intervention Model


Of course, no SLP would ever adopt a language intervention hierarchy without adaptations for a child and the contexts in which he or she functions. Slavish adherence to a developmental hierarchy is inappropriate for two reasons. First, the typically developing child’s hypothesis testing of language rules occasionally results in nonproductive strategies. For example, young children learn a few irregular past tense verbs early in their language development. On learning the regular past tense -ed rule, these children apply it to the previously learned irregular verbs. This tactic results in such delightful forms as eated and sitted. No SLP would wish to adopt these forms as training targets, even though they appear in the language of children developing typically. Second, good teaching may suggest alternative hierarchical teaching patterns (Elbert & McReynolds, 1985; Powell, 1991). For example, children developing typically acquire the verb to be as both an auxiliary verb and as a main verb or copula. In intervention, therefore, these forms might be targeted separately. Our knowledge of carryover suggests, however, that we train them together, making little distinction between the forms and aiding generalization. An SLP should be aware of the prerequisites for successful communicative behaviors at the functioning level of a child. The child learning plurals need not be able to count but must have a notion of one and more than one. Likewise, successful use of why questions and answers requires an ability to reconstruct events in reverse. These cognitive skills may need to be taught prior to attempting the linguistic manner for noting this knowledge. Similarly, the child needs to understand the requirements and demands of different communication situations to communicate effectively within them. For example, the requirements of classroom give-and-take are very different from having a face-to-face conversation or from talking on the telephone. As with much learning, simple rules are combined and modified or enlarged to form higher-order rules. By carefully analyzing each new training target and monitoring progress, an SLP can ensure that a child possesses the appropriate rules for new learning. It is best not to change too many aspects of the training situation at one time. For example, words used frequently by a child should be selected to train longer utterances. New words and new forms together are too challenging. Children with LI will not present textbook examples of language development hierarchies. Language development and impairment can be very individualistic and may not follow the dictates of a developmental hierarchy. Aspects of language will develop at rates influenced by perception and cognition, opportunity, needs, and training. Of more importance for intervention is the designation of training targets that help the child function more effectively within the everyday environment. The language rules observed by most children at each level of development are valid for those children at that time. For example, young children say such things as “Mommy eat” and “More juice,” which demonstrate adherence to simple word sequencing rules based on semantics. Children demonstrate rules appropriate to their level of linguistic competence. At various levels of intervention, it is appropriate to target child rules rather than the more difficult adult ones that will be trained later. A child with LI who is forming negatives, such as no + noun + verb, should make a logical progression to noun + no + verb, rather than to the adult rule with full auxiliary verb. To require children with LI to use adult sentence forms seems ridiculous, especially when we do not require such behavior from children developing typically. As adults, we sometimes think that the adult way of doing things is the only way. Even the expectation that a child will use a new or adultlike language rule or feature following brief periods of intervention may be unrealistic (Fey, 1988). Children developing typically learn and extend or retract their language rules gradually after many encounters and trials. Over time, these rules come


Part 3 Intervention

to resemble those of adults. Therefore, it is inappropriate to expect near perfect performance from children with LI shortly after a target is introduced. Rule learning is complicated and time-consuming. In addition, children with LI may form rules very different from those intended by SLPs, therefore necessitating additional training. As a child progresses, the language training should be modified accordingly. In other words, the SLP ups the ante (MacDonald, 1985), or requires performance just above the child’s current functioning level. FOLLOWI NG TH E CH I LD’S LEAD Often, the expectation that a child will not communicate effectively becomes self-fulfilling. If facilitators expect a child to communicate and plan for it, the child will. It is important that the facilitator attend to the content and intent of each child utterance and respond appropriately. Thus, “teaching occurs when a child is attending and because the language being taught to the child is a positive consequence” (Warren & Rogers-Warren, 1985, p. 7). Language facilitators can choose either to direct and maintain a child’s attention or attend to what interests the child (Kovarsky & Duchan, 1997). Although the former is a trainer-oriented approach (or adult-centered) that gives the trainer virtual control of the entire interaction, it may not be the most effective approach. For example, children with ID are less likely to follow such trainer attempts to redirect attention (Landry & Chapieski, 1990). In contrast, these children learn object-vocabulary relationships more easily at least when the trainer follows their attentional lead (P. Yoder, Kaiser, & Alpert, 1991; P. Yoder, Kaiser, Alpert, & Fischer, 1993). A more child-centered approach guarantees joint or shared reference, enhances semantic contingency, and reduces noncompliance by a child (McDade & Varnedoe, 1987). With semantic contingency, an adult comments on a child’s topic or previous utterance, thus facilitating processing by the child. Children appear to attend most to and be best able to comprehend speech during jointattention activities (Tomasello & Farrar, 1986). Responses to child actions or utterances provide contextual support (Duchan, 1997). Such support aids the processing of children with ID who have memory storage and retrieval problems that complicate encoding and decoding (Mervis, 1990). A child’s verbal behavior should be interpreted by others in terms of its possible intention, rather than viewed as inappropriate or incorrect. In other words, a request is still a request even though the form may be wrong, the item desired misnamed, and so on. When an adult has an agenda different from that of a child, the interaction is diminished. Such interactions are at cross-purposes and are faulty (Duchan, 1997). Children signal those things in which they are most interested by their actions or through verbalizations. This gauge can be used to keep child interest and motivation high in the intervention setting. Often, I will say to a child,“What toy do you want to play with?” Although the topic is open-ended, the technique is very specific—as we see later—permitting a flexible choice of topic. When a child initiates an interaction and is responded to accordingly, the value for learning is greater than when a child’s initiation is ignored or penalized (Duchan, 1984). Ignoring or penalizing a child will result in a decrease in future initiations. While observing a lesson in a training apartment in preparation for a young man’s move to his own apartment, I overheard the following exchange:

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SLP: What are you doing? Client: (Matter-of-factly) Dusting furniture. SLP: Good. What else are you doing? Client: You live in apartment? SLP: You didn’t answer my question. What . . . The client obviously was interested in living arrangements and would have joined such a conversation willingly if the SLP had followed his lead. The SLP should follow the client’s content and manipulate the conversation to encourage the desired language features. Continued use of directive responses by this SLP will diminish the client’s initiating behavior. ACTIVE I NVOLVE M E NT OF TH E CH I LD Language acquisition occurs with the active participation of the learner. Language learning is not a passive process. In like fashion, more rapid learning occurs when a child with LI is participating actively in some event. In general, the more actively involved the child, the greater and more stable the generalization. Ideally, intervention should consist of motivating participatory activities with the potential for a variety of language use contexts (Duchan, 1997). H EAVY I N FLU E NCE OF CONTEXT ON LANG UAG E Context can be a big determiner of what is said and how it is said. Language is a socially based cultural form whose use reflects an individual’s linguistic, interpersonal, and cultural competence within a given contextual situation (Rice, 1986). An individual’s knowledge of the event or situation influences the way he or she uses language in that situation. Language intervention should occur within the contexts of everyday events and within the context of conversational give-and-take or of other communication events. The language facilitator needs to create a rich context in which a child with LI can experience a variety of linguistic and nonlinguistic stimuli and be supported in his or her linguistic attempts. The integration of talking and listening within conversations should be emphasized. The content for these dialogues is the common experience of the intervention setting. Ideally, this setting reflects or is a part of a child’s everyday environment. The child and the facilitator talk about the focus of the activities used in training. The skillful facilitator can manipulate both the linguistic and nonlinguistic context to attain desired targets from the child. FAM I LIAR EVE NTS PROVI DI NG SCR I PTS A script is an internalized set of expectations about routine or repeated events organized in a temporalcausal sequence. As such, scripts contain shared event knowledge based on common experiences that aid and enhance memory and comprehension (Constable, 1986; Furman & Walden, 1989; Lucariello, Kyratzis, & Engel, 1986; K. Nelson, 1986). Scripts provide structure that describes appropriate sequences of events in particular contexts. Routinized events for which children have scripts provide specific situations in which children can learn appropriate language (Kim & Lombardino, 1991). Familiar activities of high interest, such as


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making popcorn, pudding, or cake, can be used as the contexts for language intervention. The event sequences contained in scripts can be used to teach language expression and comprehension and recall (Duchan, 1986b; 1997; Kim & Lombardino, 1991; Ross & Berg, 1990). Scripts have been used to improve both functional communication and group play among preschoolers (Neeley, Tipton, & Neeley, 1994). In addition, verbal routines and expansions have been linked to changes in MLU and generalization of language performance across different partners, contexts, and interactive styles (P. Yoder, Spruytenburg, Edwards, & Davies, 1995). Naturally, scripts will differ with a child’s maturational level and, to some extent, with the individual, although even very young preschoolers remember events in an organized manner similar to adults in general structure and content. As children mature, their scripts become longer, more detailed, and contain more options (“Sometimes . . .”), alternatives (“You either . . . or . . .), and conditions (“If . . . , then you . . .”) (Fivush & Slackman, 1986; K. Nelson, 1986; Slackman, Hudson, & Fivush, 1986). Individual differences may be the result of different experiences. In general, specific event experience is more important than age alone (Chi & Ceci, 1987; Ross, 1989; Ross & Berg, 1989). The resultant personal scripts are more important for memory than a vague generic notion (Ross & Berg, 1990). Individual experience becomes especially important when we consider intervention with CLD children. DESIG N I NG A G E N E RALIZATION PLAN FI R ST Considerations of generalization are essential to treatment program design and should be identified prior to beginning training. Table 9.2 is a suggested generalization plan format. In designing such a plan, an SLP considers the individual needs of the child and environment and the relevant variables that will affect generalization.

Generalization Variables To ensure generalization to the everyday environment of a child, the SLP must manipulate the generalization variables most likely to result in that outcome. The variables that affect generalization can be grouped as content and context variables (Table 1.2). Content variables include the training targets and training items. Context variables include the method of training, language facilitators, cues, contingencies, and location of training. Each of these variables and considerations for intervention as they relate to a functional model is discussed in this section, expanding on the brief presentation in Chapter 1. TRAI N I NG TARG ETS As mentioned previously, teaching the complex process of language use as discrete bits of language actually can retard growth. Language intervention should be relevant to the particular needs of a child within the communication environment and target the language process, rather than language products or units. Therefore, intervention must answer two questions (Warren, 1985): 1. What will be the function of the forms and content we are teaching? 2. Are the forms and content being trained in the context of communication events in which the intended function can actually be accomplished?


Possible Generalization Plan Format

Training targets: Identify settings, situations, and persons across which training can occur. Settings: Situation:

P e r s o n s












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In general, more frequently used targets are more relevant to a child’s world and, therefore, are more likely to generalize. Communicative utterances observed to occur in the home, albeit incorrectly, can be introduced in therapy as natural outcomes of the context. Once introduced, they can be modified by the facilitator. Language is usually acquired more rapidly and used more effectively if “communicative interaction” is established first (Rieke & Lewis, 1984). Language targets need to be those that increase the effectiveness of a child as a communicative partner. The first goal of intervention should be successful communication by a child at the present level of functioning. As mentioned, developmental guidelines can aid target selection but should be followed cautiously. Remember that a development “description” of normal acquisition is not a “prescription” for the way language must be taught (deVilliers & deVilliers, 1978). In forty-three published language-intervention studies, those that used goals approximating a developmental sequence were more successful that those that did not (Bryen & Joyce, 1985). In general, most earlier emerging forms can be learned in fewer trials and prior to later emerging forms. In addition, earlier emerging forms seem to generalize more readily into a child’s use system and at a higher level of use (Dyer, Santarcangelo, & Luce, 1987). A functional model would suggest teaching forms useful in the natural setting while attending to the developmental order of these forms (Dyer et al., 1987). Although the development of typical children can serve as a general guideline, the overriding criterion for target selection should be to aid the child in communicating what is necessary in the contexts in which she or he most frequently communicates. This practical approach is especially important for children who experience pragmatic difficulties, such as with TBI or psychiatric disorders (Audet & Hummel, 1990; Ben-Yishay, 1985; Russell, 1993). The best way to determine need is through environmental observation. If, for example, a child frequently requests items in the environment but is generally ineffective, then requesting might be chosen as a target. When there is very little opportunity for a possible training target to occur, it might be best to identify other content for training. Infrequent opportunity for possible training targets to occur may be the result of low environmental expectations or requirements for a child to produce these forms or functions. For example, there may be few opportunities for children to ask questions when there is little expectation that they will do so. In such cases, low expectations can become self-fulfilling. The communication environment may need to be restructured to facilitate use of newly acquired communication skills. An SLP should identify both targets and everyday situations in which each target is likely to occur and in which its use will be affected by and, in turn, affect the context. For example, questions should be trained in situations in which they make sense and in which they perform their intended function of gaining information. SLP instructions such as “I’m coloring a picture. Ask me what I’m doing” violate the function of questions. Usually, we do not ask questions for which we already have the answer. Similarly, an SLP’s attempt to elicit an answer with the instruction “What am I doing?” also violates the function of questions and answers. Although we might wonder about the mental capacity of SLPs who do not know what they are doing, we can modify both the situation and the cue to elicit an answer more appropriately. For example, the SLP might sit behind a screen, give clues, and ask the child, “Can you guess what I’m doing?” TRAI N I NG ITE MS An SLP should plan to train enough examples of the feature being targeted to enable a child to generalize to untrained members (Stremel-Campbell & Campbell, 1985). For example, it is neither desir-

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able nor possible to train all noun-verb combinations. The goal should be to train enough examples from the noun class in combination with examples of the verb class so that the child will generalize the rule noun + verb to all members of these two classes. Obviously, this process is being simplified in this discussion, and more planning and thought are required. In addition, a sufficient number of items must be trained so that a child can determine both the relevant and irrelevant aspects of the communication context. For example, words or phrases such as yesterday, last week, and in the past are relevant to use of the past tense. The child forms a hypothesis that states, “In the presence of yesterday, last week, or in the past, use the past tense.” Other aspects may be irrelevant, such as the specific nouns, pronouns, or verbs used. For example, the pronoun I is irrelevant and can be used with any tense. If the child is trained to use the form Yesterday, I . . . , Last week, I . . . , and In the past, I . . . , the resultant incorrect hypothesis might be “In the presence of I, use the past tense.” Knowledge of both the relevant and irrelevant aspects of the context are essential for learning. Not all word classes require the use of all training targets. For example, nouns do not take the past tense marker -ed, and tomorrow does not signal use of a past tense verb. A child needs to learn those response classes in which the target is required and those in which it is not. Initially, training response classes should be similar so as to limit irrelevant dimensions. For example, the child first may learn to use regular past tense with yesterday. Such words as today do not signal the tense as clearly and should be introduced later. Gradually, more irrelevant dimensions, such as longer sentences, are introduced. When a particular syntactic form or function is being targeted, it is especially important to select content words or utterances already in the child’s repertoire. With the targeting and introduction of new topic words, an SLP selects familiar structural frames. This principle is called “new forms–old content/old forms–new content” (J. MacDonald, 1985). Processing constraints found in all human beings reflect the limited capacity of the brain to process information. When these boundaries are reached, performance sacrifices or tradeoffs must occur in one area because of demands in another. For example, children omit more grammatical markers in longer, more complex sentences than in shorter, less complex ones (Nakayama, 1987). Children with LI are particularly susceptible to these constraints because the automatization of linguistic processing takes longer. Training items that exceed the information-processing constraints of these children may result in inadequate learning and poor generalization (J. Johnston, 1988a). Often a language feature fails to generalize because a child has not learned the conditions that govern its use. For example, if a child learns by imitation, he or she internalizes the variables that affect imitation, not the variables found in conversation. In order for a behavior to generalize to another context, such as conversation, the behavior must be related to the variables found in that context. Because a young child lacks metalinguistic awareness, rule explanation is not a viable clinical tool. An SLP must structure the environment so that linguistic regularities are obvious. Contrast training is one method of overcoming generalization problems (Connell, 1982). In contrast training, a child learns those structures and situations that obligate use from those that do not. For example, use of the third-person -s marker is required with singular nouns and third-person singular pronouns. A child must recognize also that plural nouns and other pronouns do not require this marker. Conversational use requires recognition of the linguistic contexts within which the training target does or does not appear. The identification of other contexts, such as events, facilitators, and settings, also should be accomplished. Using several different contexts ensures that a child does not identify the SLP and the therapy setting as the only contexts in which to use the language being trained.


Part 3 Intervention

Ideally, functional training uses multiple examples (Stremel-Campbell & Campbell, 1985), such as the several categories of linguistic response classes or training items, several facilitators, and several settings. This feature is essential for generalization. M ETHOD OF TRAI N I NG In the past, language was taught much as one would teach any other complex behavior, and intervention centered on individual discrete behaviors. The goal was to increase the frequency of targeted language features. Language, however, is a set of rules that allow a person to use these language features in communication contexts to express intentions. A rule is an abstraction that describes similarities. Language is rule governed. Thus, the goal of intervention should be to learn the abstract rules, rather than the behaviors that reflect these rules. Many methods of teaching language do not reflect this goal (Connell, 1987b). There is a discrepancy between the goals and the methods of teaching. It is not practical with most children and most intervention targets simply to explain the language rule being trained. Instead, training needs to be limited to observations of the rule being applied within situations that contrast the critical conditions that apply to the rule (Connell, 1987b). For example, can you imagine trying to teach regular past tense to a child as follows: When a verb is used in the past, an -ed is added to it to produce a past tense verb, as in walk/walked. Instead, we might teach regular past tense in the following manner: Every day I walk, yesterday I walke d. Every day we talk, yesterday we talke d. The word yesterday tells us to add the /t/ sound. Now you try it. I’ll start. Every day I walk, yesterday I _____. Every day they rake, yesterday they _____. An SLP’s role is to provide organized language data to a child as an illustration of rule use. Thus, the child would be presented with paired minimally different situations that do and do not invoke the rule (Connell, 1987b). For example, these situations could be sentences in which the use of a form, such as pronouns, is alternately appropriate and inappropriate. Pronoun use might be contrasted with noun use. SLP: We’re going to play imagination. I’ll tell you about something in my mind and you try to find the picture. I’m thinking about a ghost. He has a big nose. Wow, you found that really fast. Okay, you think of something else. Child: It has blue eyes. SLP: I don’t know what you’re talking about. What’s the name of it? Child: A doll. SLP: Um-hm. What about the doll? Child: It has blue eyes. SLP: I found the doll with blue eyes. It’s easy when I know what you’re talking about. Try another. I’m thinking . . .

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Child: Thinking of a dinosaur and he’s got sharp teeth. SLP: Oh, I know which dinosaur has the sharp teeth. By presenting these contrasting situations and encouraging the child to practice, the SLP helps the child amass the data necessary to identify the critical elements of the rule. Once the child is aware of the critical elements, the SLP has the flexibility to present these elements in any communication situation. The strength of the rule-teaching approach is in the way it simplifies the learning task by condensing relevant input and highlighting critical conditions (Connell, 1987b). Unfortunately, not every form has a direct link to some function. The passive voice, for example, does not have a clear function and may be used to answer, comment, reply, declare, and so on. Forms that do not have a clear direct function are more difficult to teach. Rules based on abstract grammatical categories are also difficult. Functional techniques are effective because they incorporate behavioral principles and also use the context of naturally occurring conversations that can be modified systematically by the language facilitator. For example, the following exchange might occur with a child for whom we have targeted future tense. SLP: That sounds like fun. What about tomorrow? Child: Zoo? SLP: What about the zoo? Child: Go zoo. SLP: Now? Child: Go zoo tomorrow? SLP: You will? John will too, right. Tomorrow you both. . . Child: Will go zoo. SLP: I love the zoo. I wonder what will happen there. Generalization is more likely than with more structured approaches because the cues used resemble the varied ones found in communication events. In addition, the child’s attention is focused on objects and events in the environment while the child is receiving linguistic input about those objects and events (Warren & Kaiser, 1986a). A functional model provides a dynamic context for teaching language. Language training that works for a child in communication events should generalize to those events. The focus should not be merely the correctness of a child’s language, but its communicative potential (Bauer & Sapona, 1988). In general, functional intervention in combination with more structured remediation facilitates both acquisition and generalization of language targets to usage within natural environment situations. The functional approach involves (a) selecting appropriate language targets for a child and environment, (b) arranging the environment to increase the likelihood that a child will initiate, (c) responding to a child’s initiations with requests for elaboration of the target forms, and (d) reinforcing a child’s attempts with attention and access to objects in which the child has expressed interest (Warren & Kaiser, 1986b). Interactions between adults and children arise naturally in unstructured situations, such as play, and can be used systematically by the adult to give the child practice in communication. A child signals a potential topic by demonstrating interest or requesting assistance. Thus, the child provides the topic and the opportunity for the facilitator to teach the language form (Duchan, 1986b). The child is more likely to talk and be more interested in the content of this talk if the topic has been established by the child.


Part 3 Intervention

Within these communication contexts, an SLP models the responses that fulfill a child’s communication goals. Because the purpose of language already is established in the natural environment, form and content may be learned more easily. In short, the child is taught a more effective way to communicate within a particular context (Audet & Hummel, 1990). The SLP also models behaviors for the caregivers in order to facilitate training and increase the likelihood that situations will occur in which the child is successful. When the desired interactions do not occur, the SLP can manipulate the environment to enhance its language-training potential (J. Norris & Hoffman, 1990a). Both linguistic and nonlinguist aspects of the context can be altered to elicit the desired communication. Activities can be planned around communication contexts that are highly likely to occur for the child. Training outside the normal environment should be as close to that environment in materials, situations, and persons as possible. Activities should include a child’s usual reasons for talking and typical topics, rely on previous experiences and introduce new ones, use familiar focuses of communication, and include the child’s normal communication partners (Spinelli & Terrell, 1984). Each child’s individual learning or cognitive style also must be considered by the SLP. Children are most comfortable with new experiences and information presented in a manner consistent with that style. In part, learning styles are culturally based, a consequence of accumulated experience (Saville-Troike, 1986; B. Terrell & Hale, 1992). For example, extended families, such as those in many Asian and Hispanic cultures, may foster a less independent style of learning than more nuclear families. Studies also have demonstrated that African American children benefit from incorporation of physical activity and movement into the learning situation (Hale-Benson, 1986, 1990a, 1990b). The SLP must recognize that events within a child’s everyday environments will differ in the amount of structure provided by the event itself (Duchan, 1986a). Some contexts are highly planned and scripted or routinized, such as bathing or eating, whereas others are relatively free and open, such as playing. The communication demands and the expectations on a child vary accordingly. Language intervention must recognize what a child brings to each context and what is demanded in return. New information should be organized to meet the functioning level of a child (J. Norris & Hoffman, 1990a). Routines may provide the best vehicle for training a child who is noninteractive. A child can ease into participating through repeated exposure to a routine in which the facilitator models actions and communication. Because the event is prescribed and expectations are known, there is some security for a child. Likewise, discussions of familiar events, such as a birthday party, provide a script for communicating. Routine event knowledge shared with a communication-facilitating adult provides the scaffolding for communication. Routines provide structure and expectations, freeing cognitive-processing abilities for linguistic processing (Lucariello, 1990). Overall, varied linguistic features are more likely to occur in familiar, meaningful contexts (Lucariello et al., 1986). Language treatment based on play and daily life experiences is similar to normal language-learning processes. By considering why and how children use words and gestures, an SLP increases his or her ability to provide the most natural and optimal situations for eliciting and teaching communication. The combination of appropriate context and specifically targeted language features facilitates maximum carryover and generalization outside the clinical environment (Kunze, Lockhart, Didow, & Caterson, 1983). Data from a number of studies indicate that functional intervention (a) teaches target skills effectively; (b) aids generalization to nontraining settings, times, and persons; and (c) improves both the formal and functional aspects of language (Warren & Kaiser, 1986b). The technique works well with a variety of age groups and populations with LI and with a variety of specific language responses. Lan-

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guage training generalizes to classroom and home settings and to teachers and parents. In addition, the general effects of the technique are beneficial to the overall language learning and functioning of the child (Rogers-Warren & Warren, 1985). LANG UAG E FACI LITATOR S If the goal is language use within a child’s everyday context, then a lone SLP working only in a clinical setting is limited as to what he or she can accomplish. The brevity of child–SLP contact necessitates the use of a wider variety of social contexts, including various communication partners. These partners supply a strong social base for intervention, providing a reason for language use (Paul, Looney, & Dahm, 1991). An SLP need not question whether these partners should be involved, but rather how they should be involved (Olswang & Bain, 1991). The appropriate partners to be used in training will vary with the age and circumstance of the child. Whereas parents may be appropriate for preschool children, they may have more limited interaction with their school-age children for whom teachers and peers may be more effectual. Successful use of the language taught in intervention programs depends, in part, on the expectations of these significant others in the child’s environment. Parents have been successful language facilitators with their children (Broen & Westman, 1990; Fey, Cleave, Long, & Hughes, 1993; Whitehurst et al., 1991). Most success has been reported for children in early stages of language and cognitive development (Girolametto, 1988; Tannock, Girolametto, & Siegel, 1992; Weistuch & Brown, 1987; Whitehurst et al., 1991; P. Yoder et al., 1991). For example, parents of children with ASD have been taught to provide intervention services within the daily routines of their preschool children at home (Kashinath, Woods, & Goldstein, 2006). Without intervention, is often difficult for toddlers with LI and their parents to establish mutually rewarding interactional patterns. Such children are less likely to succeed in a preschool setting. Their experience level and their success in communicative interaction are often minimal, and they may exhibit poor listening skills. Children who are not successful in communication often become resistant or negative and develop attention-getting behaviors. A child must have the opportunity to communicate; thus, a facilitator must be attentive and responsive. A facilitator must consistently recognize a child’s attempts to communicate and provide appropriate responses (Wilcox, Kouri, & Caswell, 1990). Parents need to be taught more than just modeling language and their progress as trainers must be monitored (Fey, Cleave, & Long, 1997). Communication partners, such as teachers and parents, can be an effective part of an intervention team if they are trained and monitored thoroughly (Jimenez & Iseyama, 1987). A facilitator must be trained in both (a) the how, or the best teaching techniques, and (b) the what, or the goals and materials for intervention. Training of facilitators can be accomplished in a combination of ways, including direct training and modeling, in-service training, and the use of telephoned and written/illustrated instructions. To provide effective intervention services at home, parents need realistic input. For example, training might include user-friendly written handouts explaining the teaching strategy and/or target, video-recorded and live demonstrations, practice and critique, and discussion. Caregiver Conversational Style According to the interactional model in this text, the difficulties experienced by children with LI reflect their everyday contexts as much as their so-called disorder. If this is so, then conversational partners must assume some of the responsibility for the communication of these children. For example,


Part 3 Intervention

although adult interaction-promoting strategies, such as extended conversations and questions to promote turn taking, are positively related to language productivity in preschool children, adults in childcare centers are more responsive to the context of interactions than to the language abilities of preschool children (Girolametto & Weitzman, 2002). If we want change to occur, we need to change adult behaviors. The quality and quantity of spontaneous conversational behavior of children with LI are negatively related to the number of verbal initiations and directives by their adult conversational partners. Partially in response to these children’s language deficits, adults modify their own language. Mothers of children with LI repeat more than do mothers of children developing typically. Most of these maternal repetitions are imperatives (demands) or directives (commands). The frequency of these parental directions and of self-imitations is negatively correlated with the rate of a child’s language growth. In a highly directive interaction style there is often no connection between the directive and any utterance of the child. Adult verbal control of interactions also seems to affect adversely the verbal output of children with LI. For example, although the question-answer style of adult communication may aid children functioning around age 2 to maintain a conversational topic, it can discourage children from commenting outside the topics initiated by the adults (Mirenda & Donnellan, 1986). As children with disabilities and those without move beyond this developmental level, the use of a question-answer strategy is counterproductive to the goal of spontaneous conversational behavior. An adult directive style includes verbal conversational behaviors that (a) control and initiate conversational topics, (b) lead the conversation, and (c) structure the nature of the child’s contribution (Mirenda & Donnellan, 1986). These behaviors ensure a cohesive and fluent conversation at the expense of the child’s spontaneous initiations. In contrast, the use of an adult facilitative style of conversation can increase the use of topic initiations, questions, and topic comments by children with LI (Mirenda & Donnellan, 1986). An adult facilitative style (a) allows a child to control and initiate conversational topics, (b) follows a child’s conversational lead, and (c) encourages a child to participate in various ways. A facilitative adult is less interested in conversational flow than in providing an opportunity for a child to participate and to assume control of the conversation. Specific behaviors that define each style are given in Table 9.3. Several conversationally based parent-training programs have demonstrated an increase in parent responsiveness and a decrease in directiveness toward their preschool children with LI (Broen & Westman, 1990; Mahoney & Powell, 1986; Weistuch & Lewis, 1986). Other changes include increased willingness to follow their child’s lead, more equality in turn balancing, shorter parental MLU, and fewer questions. Mothers who receive facilitative training are more responsive to and less directive of their children’s behavior than are untrained mothers (Girolametto, 1988). These changes in parental behavior are related to such child language changes as increased MLU, increased number of utterances, increased lexicon, and improved standardized test scores. Children whose parents receive training initiate more topics, are more responsive, use more verbal turns, and have a more diverse vocabulary. These results suggest that the effect of parental conversational strategies may be greater on semantics and pragmatics than on linguistic form. An increase in the percentage of semantically related or contingent utterances can, in turn, provide greater opportunity for topic maintenance and turn taking. With more opportunity to participate, the child gains more control over both the adult’s behavior and the exchange process.

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Characteristics of the Directive and Facilitative Styles



Initiate at least half of the topics of conversation.

Initiate fewer than half of the topics of conversation.

Use direct questions to initiate most topics.

Use indirect questions or embedded imperatives to initiate most topics.

Use primarily direct questions and occasional imitations or expansions to maintain topics.

Use primarily direct statements, encouragements, imitations, expansions, or expansion questions and occasional direct questions to maintain topics.

Do not ask for clarification directly, relying instead on encouragement, imitation, and expansion strategies.

Use direct clarification questions or statements when necessary and appropriate.

Do not allow lapses in turn taking to occur, but use direct questions to require the child to respond.

Allow lapses between turns to occur and after a short wait, initiate topics as noted above.

Children’s spontaneous verbalizations can be enhanced when adult facilitators provide a high level of verbal feedback coupled with little verbal directing (Broen & Westman, 1990). Examples are given in Table 9.4. Data from several studies suggest that children’s conversational abilities can be increased by adult behaviors that are highly responsive to a children’s spontaneous communicative behaviors. Language facilitators plan their role in the communication event and their communication turns to maximize the learning opportunity for a child. Within each turn, the facilitator responds to the child while troubleshooting the child’s previous utterance, maintains the conversation by taking a meaningful turn, and provides an opportunity for the child to respond (see Table 9.4) (Craig, 1983). The use of parents, teachers, and others as language facilitators does not diminish the role of an SLP. It is essential that he or she remain very involved in the intervention and also become a facilitator. Whereas parents sometimes find it difficult to adapt their behavior to a more facilitative style, SLPs TABLE 9.4

Examples of Minimally Directive Verbal Feedback to Children

Child: I went to the zoo, yesterday. Partner: Oh, that’s one of my favorite spots. I love the monkeys best. Child: I have a birthday party, tomorrow. Partner: Oh, that should be fun. What do you want for your birthday? Child: We went whale watching on vacation. Partner: I’ve always wanted to do that. Bet it was exciting. Tell me about it. Child: My picture is a cowboy. Partner: A big cowboy on a spotted horse. Child: I’m gonna be a ghost for Halloween. Partner: Don’t come to my house; I’m afraid of ghosts. I think I’ll be a witch and scare your ghost. Note: In each of these five exchanges, the adult followed the child’s lead by commenting on the child’s topic and then cueing the child to provide more information or waiting for a reply.


Part 3 Intervention


Guidelines for Implementing a Family-Centered Collaborative Model

Define your role and explain your approach to intervention. Convey respect by 1. 2. 3. 4. 5. 6. 7. 8. 9.

Providing real choices for the family and encouraging them to make decisions Providing requested information and services immediately Ensuring confidentiality Recognizing cultural/ethnic values, traditions, and beliefs Explaining the purposes of procedures and methods Providing a rationale for procedures and methods Ensuring a role for the family in both assessment and intervention Meeting at times and locations convenient for the family Attending to family concerns before professional concerns

Ensure that the family attends all discussions and decision-making meetings. Use language that can be comprehended easily by the family. Speak to family members forthrightly, completely, honestly, and in an unbiased manner. Design intervention plans to fit the family’s routine. Be flexible in intervention planning. Source: Adapted from Crais (1992); B. Johnson, McGonigel, & Kaufmann (1989); McWilliams & Winton (1990).

can more readily provide this input on a consistent and uniform basis (Fey et al., 1993). Best results seem to occur when other facilitators receive frequent, regular, structured training, including roleplaying and critiques. Family-Centered Intervention There is a distinct difference between parental involvement and family-centered or family-focused services in which all family members participate (Crais, 1991). Public Law 99-457, regarding education of special needs populations, focuses on the family as integral to intervention. In a family-centered model, families are treated as valued, equal partners and are encouraged to participate at all stages of decision making. Families are recognized as a constant in a child’s life, while special services are recognized as more transient by nature. In such an arrangement, the SLP–family relationship becomes a collaborative one. The aspects of this collaborative model are presented in Table 9.5. Although each family is individualistic, culture is one of the most important influences on it, affecting such aspects as structure, interaction, function, and life cycle. Family structure includes the number of individuals and types of relationships, but more important, the cultural values and beliefs about family structure. Family interaction is the way family members relate and the roles they play within the family. The relative importance of certain roles will vary with the culture. For example, a child who is an unmarried adult will be treated very differently, depending on the family background. Interactions are governed by the cohesion of the family, its adaptability or ability to change, and patterns of communication (Summers, Brotherson, & Turnbull, 1988). Family functions are the responsibilities that families are expected to assume for their members. Again, this aspect of families varies widely across cultures. Some cultures may value overprotection of children more than an SLP’s goal of increased independence.

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A Functional Intervention Model


Finally, family life cycle describes the changes in families over the course of their development. Nuclear families may have periods of isolation after children have grown or in old age, whereas extended families may not experience this phenomenon. With infants, toddlers, and preschool children, an SLP is required to design an Individualized Family Service Plan (IFSP) for the child and family. The IFSP is a plan for service, not for treatment alone, and represents a team effort that includes the family (Polmanteer & Turbiville, 2000). The origin of family-centered services is in functional theories such as those espoused in this text. A child is seen as an individual within complex relationships that are affected by the child and affect the child in return. An SLP has a perspective from which he or she views the child. Members of the family offer differing perspectives. These diverse points of view can offer insight into the communication of the child and help to explain her or his behavior. If families are going to be the vehicles for change, an SLP must try to understand each family’s perceptions, feelings, concerns, and understanding of their child with LI (Polmanteer & Turbiville, 2000). IFSP recommended practices are presented in Table 9.6. Families and Children from CLD Backgrounds Cultural identity is not a stereotype. Families within the same culture differ. Recognition of cultural contributions by an SLP, however, increase the likelihood of appropriate and effective intervention. Table 9.7 presents guidelines for SLPs to follow when interacting with culturally diverse families. SLPs should be mindful of the differing expectations and perceptions of various ethnic and racial minorities. The role of parents, the expectations for children, and the attitudes toward disability, medicine, healing, self-help, and professional intervention within a minority population should be understood thoroughly prior to intervention. For example, mothers from Puerto Rico who live on the mainland seem to hold beliefs about early education and literacy that reflect both their original TABLE 9.6 (IFSP)

Recommended Practices for Implementing Individualized Family Service Plans

Team members include family members and selected members of the family’s informal network of friends, neighbors, and other service providers, plus professionals such as the SLP. Community and culture must be considered in assessment and intervention. Family members sign the IFSP. Family members’ assessments of the child’s skills are included in reports and in the IFSP. Family members provide information on the child’s communication and communication partners. Of interest are the language(s) used, stylistic variations, roles, modes of communication, and adult expectations and teaching style. IFSP outcomes Are written in the family’s language and avoid professional jargon. Reflect the family’s concerns and priorities shared by the team. Reflect beneficial changes identified by the family. Services are provided by multiple agencies listed on the service plan in settings that are typical for the child’s age peers who have no language impairment. Source: Adapted from Polmanteer & Turbiville (2000); Scheffner Hammer (1998).


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Guidelines for Interacting with Culturally Diverse Families

Do not make assumptions based on cultural stereotypes. Cultural rules govern each encounter for both the family/child and the speech-language pathologist. Be aware that responses to stimuli, such as a clinic room, may be very different across cultures. Learn about the cultures of the families and the children you serve. Use cultural mediators or interpreters when necessary. Learn to use words, phrases, and greetings from the culture of the family/child. Be patient; allow more time for interactions. Use as few written instructions as possible, unless a family member has good English reading comprehension. Allow time for questions. Recognize that the family may not be prepared for the amount of professional-family collaboration found in functional approaches. Encourage family input without embarrassing family members. Involve the family to the extent that they wish to be involved. Ensure that goals and objectives of the professionals and the family match. Involve the cultural community when possible. Source: Adapted from Lynch & Hanson (1992); Wayman, Lynch, & Hanson (1990).

culture and more North American notions (Hammer, Rodriguez, Lawrence, Miccio 2007). Children and professional intervention services are viewed quite differently across Asian, Hispanic, and African American cultures. Likewise, an SLP’s conversational style may have a great effect on future involvement with members of that community (Matsuda, 1989). Successful SLP–family collaboration should be characterized by mutual respect, trust, and open communication (Wayman et al., 1990). These characteristics only evolve when an SLP is sensitive to the cultural background of the families with whom he or she interacts. Although I have tried to make the teaching techniques mentioned in the next chapter culture-free, the model of intervention proposed in this text is based primarily on North American psycholinguistic research of white, middle-class families and, therefore, contains an implicit cultural bias (van Kleeck, 1994). The use of these techniques with parents and children from CLD backgrounds is not cultureneutral. When we ask mothers to use these techniques at home, we need to be very sensitive to cultural differences that define how parent–child interactions occur (Johnston & Wong, 2002). These interactions reflect cultural beliefs about the roles of parents and children and the ways in which language is learned. For example, children may be expected to be quiet and not to speak. In the reverse situation, a toddler’s lack of comprehension may be justification for a parent’s speaking infrequently with a child. An SLP must determine these cultural belief systems and modify intervention techniques accordingly. Otherwise, intervention may be less effective, or worse, parents may actively resist intervention efforts. Information can be gleaned from reading research studies, talking with community representatives, and working closely with parents. One caution: Anthropological studies may describe broad national beliefs while glossing over local differences or may do the reverse, studying one unique community within a larger culture. Nothing beats getting involved with the cultural community, attending religious services, clubs, and festivals, and talking with and listening to parents and community members. An SLP also cannot make assumptions based on catch words or oversimplifications. Let me give you one example from my own experience. I have been to South Korea twice. Approximately 40 per-

Chapter 9

A Functional Intervention Model


cent of the population there—and over 95 percent of Korean immigrants to the United States—are Christian, mostly in the big cities, such as Seoul. This fact is not exactly what it might seem to most U.S. citizens. These same believers also follow Buddhist and Confucian precepts, such as ancestor worship, deference to older people, order, and societal interdependence. Indeed, Korea is known as The Land of Morning Calm, a non-Christian Korea. At the same time, various Korean Christian denominations tend to be very myopic by our more inclusive standards, often considering other denominations not to be Christian. For example, Catholics may be referred to as non-Christian by Methodists, and the reverse. To place Western Christian notions into this context may result in misunderstanding. Your hometown version of Presbyterianism may look very different in a Korean context. Once we enter someone else’s culture, many of our assumptions must be set aside. Even when things seem similar, they may not be. If this feels a bit like Through the Looking-Glass, and What Alice Found There (1871), Lewis Carroll’s classic children’s book, you are not far from wrong. Things sometimes move in different directions than we expect. Let’s use Chinese culture as an example and explore the implications for intervention (Johnston & Wong, 2002). Based on research literature, we can make the following broad characterizations of Chinese cultural beliefs: ideal self is embedded in interdependent social relations, requiring obedience and respect of • The others over self-fulfillment and independence. behavior is very malleable rather than biologically based. • Human When a child goes to school, he or she passes from a period of nonunderstanding to one of under• standing in which the child can be expected to succeed. As a result, parents are less likely to join preschool children in play or to engage them in social communication. Instead, parents are more directive, focusing or refocusing a child’s attention. These beliefs impact intervention in myriad ways. For example, a parent may not understand our insistence on the importance of early intervention. Any discussion of this topic must include the importance of early intervention for later success in school, a Chinese cultural value. Similarly, the notion of following a child’s lead does not flow naturally from beliefs in interdependence and the nonunderstanding of young children. It might be better to help Chinese mothers construct more formal teaching lessons to be used several times each day within the home (Johnston & Wong, 2002). Note that the use of the home environment still retains the basic functional nature of intervention. Given differences in cultural beliefs, there are likely to be occasions when well-intentioned intervention recommendations run counter to cultural expectations of the family you serve. To be successful, an SLP must find “functional equivalents” that achieve the same ends (Johnston & Wong, 2002). For example, parents of young children with LI are often encouraged to engage in book-sharing activities. The goal is social communication, not book reading per se. Other methods can be found that attain the same goal while being more culturally appropriate to the child and family, such as oral storytelling. For my money, this is one of the best aspects of our profession: problem solving and finding intervention methods that work for each individual child and family. Language is one of the primary modes of socialization and acculturation for children. When a child learns a second language, such as English, in an English-intensive educational program, he or she is in danger of losing the first language. This may be especially true for children with LI who receive remedial intervention for English but no help with their initial language in which they are most likely also impaired. Given the interdependence of emotional, cognitive, and communication development in young children and the needs these children have for family support, it is important that SLPs also


Part 3 Intervention

support the home language of these children (Kohnert, Yim, Nett, Kan, & Duran 2005). This does not necessitate intervention in both languages. Potentially, well-trained parents can be as effective as SLPs in administering intervention (Law, Garrett, & Nye, 2004). As mentioned, an SLP can directly train a parent who then becomes the primary intervention agent for the child. Successful parent training requires the following (Bailey, Buysee, Edmondson, & Smith, 1992): language facilitation strategies vs. general stimulation • Specific Use of multiple sessions and instructional methods with parents • Systematic progression skills • Activities tailored for theofindividual child • Rather than suggest that parents cease using one language at home—a huge imposition, especially for families that freely mix languages—it seems best to target activities, such a book reading, in which one language would be used exclusively. Where necessary, it may be helpful to use paraprofessionals from the language community or siblings as in-home trainers. TRAI N I NG CU ES If one accepts the premise that pragmatics is the governing aspect of language, then an SLP must be concerned with the context within which training occurs. Certain linguistic and nonlinguistic contexts require or provide an expectation of certain linguistic units. In part, the problem of lack of success in generalization is due to response programs “in which children are taught specific responses to specific, often carefully worded, directions or questions” (Rieke & Lewis, 1984, p. 49). A child’s everyday world lacks this careful control. The everyday context contains many irrelevant stimuli that do not and cannot elicit trained communication behaviors. At the same time, parents and teachers may be presenting cues and prompts in such a diverse manner as to inhibit learning. They can be trained to focus their attention and to manipulate the environment to elicit the behaviors desired (Lucariello, 1990). Within an approach in which conversational partners respond to all communication attempts by a child and prompt additional presponses, an increase in the number of child utterances and vocabulary is associated with increased talking and the use of questions by an adult (Kaiser & Hester, 1994). Too often, the traditional approaches rely on very narrow and somewhat stilted cues unlike those found in conversation. The use of these traditional cues, such as “Tell me the whole thing,” may result in training characterized as “apragmatic pseudoconversational drills” (Cochrane, 1983). Pragmatically, the cues do not make sense—for example, asking a question to which the speaker already knows the answer. As a result, the conversations within which training occurs are little more than drill with a conversational veneer. Verbal and nonverbal cues can be varied to ensure that the child does not become dependent on one stereotypic stimulus. A system of least prompts can be used, in which an SLP rates each type of prompt from least to most intrusive and supportive (Timler, Vogler-Elias, & McGill, 2007). Through the course of intervention, the SLP works to minimize prompting whenever possible and to allow the context to prompt the targeted language features. For example, children with ASD can be taught to initiate requests and to make comments through a system of decreasing prompts, moving from sentence completion (Can I . . .) through questioning (What could you ask your friend?) to pointing to a similar written phrase (Thiemann & Goldstein, 2004).

Chapter 9

A Functional Intervention Model


Relevant, common stimuli within the everyday communication context can serve to elicit a child’s new language targets if these stimuli are included in the training (Stremel-Campbell & Campbell, 1985). Targets can be trained across several behaviors, facilitators, and settings to ensure generalization. For example, a child’s toys or everyday items and daily routines become part of the training. The systematic introduction of increasingly more irrelevant stimuli from the communication environment into the training context has been termed “loose” training (Stremel-Campbell & Campbell, 1985). The overall goals are for the newly trained behavior to be emitted in response to a variety of stimuli and for a single stimuli to result in a variety of responses. These goals can be achieved by using concurrent behaviors, response variations, and linguistic and nonlinguistic cue variations. In concurrent behavior training, relevant and irrelevant stimuli are presented together so that a child learns which ones affect the newly learned behavior. Response variation teaches a child that several responses can be used to achieve the same communication goal. For example, a drink can be attained by saying,“Want drink,”“Drink please,”“May I have a drink?” “I’m thirsty,” and, “Are you as thirsty as I am?” Use of a functional conversational approach requires an SLP to assess thoroughly the effects of certain cues and to explore the possibilities of eliciting language with a variety of linguistic and nonlinguistic cues (Constable, 1983). Those SLPs who rely on traditional cues are unaware of the rich variety of cues available for creating contexts in which language targets can occur. CONTI NG E NCI ES Once a language facilitator has elicited language from a child in a conversational manner or a child has initiated language, the facilitator can begin to modify that language if necessary. In short, the child’s utterance is the stimulus to which the facilitator responds. These responses or contingencies help form the context for the child’s utterance. Natural maintaining consequences should be identified prior to beginning training. As much as possible, these consequences should be related directly to the response. Such consequences as “Very good” and “Good talking” should be avoided (Stremel-Campbell & Campbell, 1985). When a child message (“I saw monkeys”) and the consequence (“Good talking”) are unrelated, the child’s language fails to retain its communicative value. Communication behaviors can be maintained by conversational responses (“Oh, I think monkeys are funny. What did they do?”). Often, simply attending to a child is sufficient to maintain the child’s participation. As much as possible, conversational consequences should be semantically and pragmatically contingent and should serve to acknowledge a child’s utterance. Semantic contingency, the relatedness of a parent’s or facilitator’s response to the content or topic of a child’s previous utterance, has a positive effect on the rate of language development. In the above example, “I saw monkeys,” the adult response is semantically contingent. Adult speech that is semantically contingent decreases the amount of processing a child has to do to understand and analyze the structure and meaning of an adult’s utterances. The sharing of a conversational topic and common vocabulary decreases a child’s memory load for processing and increases the ease of immediate language production. The facilitator’s utterance provides a prop or scaffolding for the child’s own analysis and production. For children with expressive vocabulary delays, the semantic contingency of adult responses has more effect on a child’s language than does the structure of the adult response (Girolametto, Weitzman, Wiigs, & Steig Pierce, 1999). In contrast, frequent topic changing or refocusing of a child’s attention by an adult impedes the child’s language acquisition.


Part 3 Intervention

It is not enough, however, just to comment on a child’s topic. In the following example, the facilitator’s response is semantically contingent but lacks pragmatic contingency. Child: I want cookie, please. Facilitator: Johnny wants a cookie. The facilitator’s response should make sense within the conversational framework. In this example, more appropriate responses would be,“What kind of cookie do you want?”“Okay, but just one,”“Help yourself,” and, “No cookies until after lunch.” This example shows why contingencies such as “Good talking” violate pragmatic contingency and do not help continue the interchange. The child’s language is reinforced more naturally when its purpose and intention are met. In brief, behaviors that attempt to increase a child’s participation in the interaction, that is, a childcentered interactional style, enhance a child’s language skills. By relinquishing some control and adopting the child’s topics, language facilitators can ensure more child participation and interest. Overall, in the clinical setting it is important that facilitators accept a child’s utterance as representative of the child’s understanding of the world and of the requirements being asked. Answers considered wrong by the adult may, in fact, represent a child’s somewhat different perspective. A child’s meaning can be negotiated by the facilitator and the child as the conversation continues. LOCATION As noted in Chapter 1, location of training includes both the physical location in which training occurs and the conversational context formed by a child and a facilitator. In many ways, the conversational context is more important for generalization because it does not depend on physical setting and transcends the clinic, classroom, and home (J. Johnston, 1988a). In the light of the flexibility of these natural communication sequences, training is more a matter of how than where (Craig, 1983). Physical Location When possible, training should occur wherever a child is likely to use the newly trained language skill. Most communication takes place within familiar events that influence the way the participants communicate. For example, storytelling, conversation, and classroom participation have different rules for participation. Therefore, language intervention should take place within these types of discourse events and others as they occur in a child’s everyday physical locations. The everyday environment provides natural and familiar stimuli for intervention and for generalization (Caro & Snell, 1989). Children with lingering pragmatic deficits, such as those with TBI, are particularly in need of environmentally based intervention (Russell, 1993). Obviously, parents and teachers will need to be trained for their new roles as language facilitators. Parents may come to a clinic or school to be trained. If this is not possible, evening group sessions or written guidelines can be used. Even if parents only modify their expectations for the child, this will help with the generalization of language training. Conversational Context Language must be evaluated and trained within some dynamic context in order to make sense. Language and communication are influenced heavily by the context of what precedes and follows (linguis-

Chapter 9

A Functional Intervention Model


tically and nonlinguistically) and by the expectations for participation with that specific context. For example, the expectations for storytelling are different from those for conversation. Ordering at a fastfood restaurant presents different expectations from chatting with a friend on the phone. Each event follows certain scripts. Sentences trained out of context are, therefore, more difficult for a child to learn. SLPs are not training static forms but a generative, versatile system. The contextual expectations and scripts must be examined prior to beginning intervention within each context. Conversations provide a dynamic context in which language serves a purpose or function. Although these conversational sequences may mirror natural sequences, the SLP and other language facilitators are mindful of the teaching potential (Craig, 1983). Communication strategies can be provided to the child as needed (Spinelli & Terrell, 1984). Teaching approaches can be adapted to this setting to approximate more closely conversational exchange.

Conclusion By carefully considering the variables that affect generalization, an SLP can modify training to maximize this effect. Targets and design decisions can be made on the basis of the likely effect on generalization and on ultimate use within the events and situations of a child’s everyday environment. Language can be elicited and modified by using techniques that mirror the conversational style used by a child’s usual partners within these contexts. Motivation is provided by a child’s desire to participate in enjoyable activities with responsive and attentive adults. Facilitators should adhere to the following guidelines: 1. 2. 3. 4. 5.

Expect the child to communicate. Respond to the child’s topics and initiations. Respond conversationally and build the child’s utterances into longer, more acceptable ones. Facilitate communication within the everyday activities of the child. Cue the child in a conversational manner to elicit the language desired.

All of these principles are discussed in Chapter 10.

10 chapter

Manipulating Context

Chapter 10

Manipulating Context



anguage is pragmatically based. The demands of the nonlinguistic and linguistic context give rise to both the form and content of the language expressed. Therefore, a primary goal of language intervention should be for a child to learn the appropriate language skills to function effectively within everyday communication contexts or environments. Within each activity, a language facilitator strives to provide an active experience with language use. It seems appropriate, then, that the SLP and other language facilitators learn to manipulate these contexts to provide a child the maximum learning possible. A facilitator’s role is “to accept the child’s spontaneously occurring verbal or nonverbal behavior as meaningful communication, interpret it in a manner that is contextually appropriate, and become a collaborator with the child in communicating the message more effectively” (J. Norris & Hoffman, 1990b, p. 78). When language can be used to achieve goals within everyday communication contexts, the chances of generalization to these contexts increases. Language acquires a purpose or function. The training becomes functional in nature. In this chapter we explore various strategies that can be used to manipulate the nonlinguistic and linguistic contexts in which language occurs. These strategies can be used within the everyday activities of a child and, thus, can become a part of that natural environment. As much as possible, natural and conversational strategies are recommended.

Nonlinguistic Contexts Speech-language pathology is so oriented toward linguistic forms of communication that it is easy to overlook the nonlinguistic aspects. Yet, the nonlinguistic context—what happens in the environment— offers a rich source for eliciting language. An SLP can manipulate the nonlinguistic contextual cues to elicit desired language and to ensure that a child initiates language. All too often, the training paradigm of a child with LI allows the child little control. Therefore, the child assumes a passive, responsive role. Certain nonlinguistic contexts naturally elicit more language than do others. For most adults, cocktail parties are more likely to elicit language than are theater engagements. Inherent in the theater experience is the necessity to remain silent during the performance. Some situations also dictate the type of language used. Most adults do not question and challenge sermons—at least not while the sermon is being delivered. In contrast, learning situations, such as in a classroom, are supposed to encourage questioning. If targets have been selected to help a child communicate better, then an SLP already has identified the contexts in which the child attempts these targets. In other words, the nonlinguistic contexts that are highly likely to elicit the target are known. Ideally, the nonlinguistic context serves to elicit the target language behavior: The SLP then can help the child modify the target into a correct form for that situation. In theory—and this is key to our success—a child who makes a meaningful response in context will be interested in that response and motivated to change it in the desired manner. This corrected response should generalize more easily to everyday use because it is being trained within the context of everyday events and conversations. Table 10.1 contains a sample of nonlinguistic contexts and the type of language each may elicit. Small group projects or tasks usually elicit lots of language from children. For younger children, roleplay and dress-up are good contexts for language. Routines also can be established within the home or the classroom for asking for desired objects or privileges.


Part 3 Intervention

TABLE 10.1

Nonlinguistic Contexts and Language Elicitation

Turn taking and requesting objects: Provide only one plastic knife for children to share as they make a fruit salad. Provide one highly desirable outfit in the dress-up corner of the class. Provide only enough art supplies for half of the children and request that children share equipment. Following directions and directing others: While working in a group, re-create the teacher’s construction-paper collage. The teacher should be careful not to supply precut paper or to help children with the color tints. The goal is to get the children to ask for help and to direct others and themselves. In groups of two, duplicate a cake decoration previously completed by the teacher. As a group, plant seeds in cups as the teacher has done previously. A more involved project might involve planting a garden, keeping the different crops straight, and making signs. Bake while following a written or pictured recipe. Put together a model by following written or oral directions. Play dumb. By making lots of mistakes, the teacher can have children direct or correct the behavior. Have a child explain how to do something known by only that child. Have children direct each other through activities blindfolded. Have the child be the teacher. Requesting information: Give only partial directions for completing a task. Put objects that the children need for a task in an unusual location so that they will need to ask for the location. Introduce visually interesting items but do not name them or explain their function to the children. Giving information: Have children explain class projects to children from another class. Have children explain class projects to parents at a special event or Parents’ Night. Have children tell about events they experienced: for example, summer vacation, a weekend trip, a birthday party. This task and explaining how something is accomplished are excellent vehicles for sequencing. Have children request information from children who need to improve their ability to give information. Have children tell make-believe stories. Reasoning: Have children try to float or submerge objects in water. Include objects that float and those that do not so that the children must find various combinations. Build a suspension bridge from straws, string, toothpicks, and tongue depressors. Design a city with transportation, schools, recreation facilities, and residential, industrial, and business areas. Play initiative games in which groups of children must solve a common problem. Make large projects in connection with class projects. For example, children might design the “perfect” world, make montages that demonstrate male and female roles, or design a board game, such as On the Way to Your Birthday, that illustrates stages of fetal development. Requesting help: Pose problems that children cannot solve themselves. Sabotage activities, such as holes in paper cups, dried markers and paints, glue bottles glued shut, not enough chairs, missing gloves and hats, and so on. The list is endless. Imagining and projecting: Set up a drama or dress-up center. Set up a puppet stage with a variety of characters.

Chapter 10

Manipulating Context


Set up simulated shops and stores or a housekeeping center. Role-play. (Role-play can elicit a variety of intentions.) Protesting: Play dumb, as in forgetting to give children peanut butter and jelly with which to make sandwiches. Miss a child’s turn or withhold needed objects. Violate a routine or an object function by using objects in novel or nonsensical ways. Give a child too much of something or more than is needed. Put away objects before the child is finished using them. Ask a child to do something that is not physically possible (but safe). Initiations: Pose problems and wait for children to initiate communication. Ask children to talk to lonely animals for you. Source: Author’s experience; Constable (1983); Kunze, Lockhart, Didow, & Caterson (1983); Staab (1983).

Within these nonlinguistic contexts, language may be elicited through the use of delays, introduction of novel elements, oversight, and sabotage (McLean & Snyder-McLean, 1988b). Delaying or waiting for a child to initiate communication is often a very effective strategy, especially after a child has mastered a desired behavior (Hart, 1985). Too frequently, adults do not expect a child to communicate, and this expectation becomes self-fulfilling when the adult communicates for the child. Let’s assume that the language facilitator is waiting for a child to initiate the interaction. The facilitator may sit near the child and look questioningly or display some interesting item while looking at the child (Hart, 1985). When the child looks at the adult, the adult does not speak for a specified period of time unless the child does. If the child does not verbalize, the adult models or prompts the desired verbalization. Novel or unexpected events can be introduced into a situation to evoke communication. Most individuals will notice and remark on such events. For example, a kitten, guinea pig, or bright toy might be found in an unexpected spot. Even children functioning at the single-word level will comment on elements in a situation that are novel, different, or changing. Oversight or forgetting by a facilitator will elicit language from a child who’s eager to become the teacher. I often play dumb, forgetting object locations or children’s turns. Needed objects, such as glue or scissors, can be omitted or used in unusual ways. Finally, sabotage of activities or routines involves taking actions or introducing elements that will not permit the activity to continue or to be completed (Constable, 1983; Lucas, 1980). My favorite example is the classroom teacher and aide who would buckle the children’s boots together and turn their coats inside out sometime during the day. One can imagine the chaos at the end of the day and all of the language elicited as children requested assistance.

Linguistic Contexts The goal of language use within a conversational context necessitates a thorough evaluation of the linguistic cues used with children in the training situation. Cues such as “What do we say?” and “Now, tell me the whole thing” are examples of pseudoconversational cues mentioned previously.


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Eliciting language through constant prodding or interrogation can be unpleasant and actually result in less talking by the child. Such communication is one-sided, with the child assuming the role of receiver or occasional reluctant speaker (McDade & Varnedoe, 1987). Linguistic contexts can be divided into those that model language with or without a child’s response, those that directly and indirectly cue certain responses, and those that do not cue these responses. A particular utterance may cue one type of behavior but not others. MODE LI NG In comparative studies, the efficacy of the modeling approach has been demonstrated repeatedly. Modeling is a procedure in which an SLP produces a rule-governed utterance at appropriate junctures in conversation or activities but does not ask the child to imitate. The technique compares favorably with more active techniques, such as question-answer, that require responses by a child (Weismer & Murray-Branch, 1989). Modeling can be used in any of the following ways: 1. As a high-frequency response in very structured situations 2. As general language stimulation containing a number of language targets simultaneously 3. As an element in comprehension training in which a child points to pictures that illustrate the utterance modeled In general, modeling closely approximates the language-learning environment of children developing typically and is an effective language-learning strategy for a child with LI. It is expected that the child will acquire some aspect of the language behavior of the facilitator and use it in a similar context later. Unlike direct instruction techniques, interactive modeling considers the child to be an active learner who abstracts the rules used in forming utterances and associates these utterances with events and stimuli in the environment. It is best to model the training target for a child prior to attempting to elicit the target. Within such focused stimulation, an SLP produces a high density of the targets in meaningful contexts without requiring the child to respond (Cleave & Fey, 1997). Two varieties of this stimulation are self-talk and parallel talk. In self-talk, an SLP talks about what he or she is doing, whereas in parallel talk, discussion centers on the child’s actions. Obviously, activities must be chosen carefully to provide sufficient opportunities for the target to occur. Focused stimulation should be semantically and pragmatically appropriate (Fey et al., 1993). The target feature is presented frequently while little pressure is placed on the child. The following is an example of focused stimulation within a conversational context: Child: Mommy made hamburgers. Mommy made ’tator salad. SLP: She must be a good cook. What else did she make? Child: A cake. SLP: She did? Yummy. Did she cook any hotdogs? Child: Uh-huh. SLP: She made a very nice picnic for the family. Did she get to play any games or did she just work? The language feature being targeted—the pronoun she—appears in the initial part of the sentence or in elliptical utterances in which shared information is omitted. Such frequent modeling plus recasts of

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the child’s utterances have been effective in facilitating use of certain language structures (Camarata, Nelson, & Camarata, 1994; Camarata, Nelson, Welsh, Butkowski, Harmer, & Camarata, 1991; Watkins & Pemberton, 1987). Although a grammatical feature can be made more salient or conspicuous by emphasizing it, this can change the basic meaning of a sentence. Say the following sentences out loud, emphasizing the boldfaced word: I’ll see you next week. I will see you next week While the first is probable, the second is definite. Or the following: I do my homework every day. I do my homework every day. We have a statement of fact followed by an argumentative accusation or defensive response. Instead, targets can be placed at the end of a sentence to aid working memory and enhance learning (Fey et al., 2003). This can occur in syntax (The girl is running to school. She really is.), morphology (He rides to work. He doesn’t walk; he rides.), or semantics (Don’t put the block on the box. Put it in.) Here’s an example of how it might work (Fey et al., 2003): Child: I do it. Adult: What about me? Child: You too. Adult: Great. You won’t do it. We will. Child: We will. Adult: Yes. We will do it together. Once a target has been modeled thoroughly, the SLP asks the child to respond in a manner similar to the model. Children who are young, low-functioning, or delayed may need imitation training, with a complete model presented immediately before their response. Imitation is a procedure in which the child repeats the language behavior of a facilitator, with the expectation that the child will acquire some aspect of the facilitator’s language. Imitation by a child enables him or her to become accustomed to the language feature being taught and its phonological patterns. This is especially important if the feature is difficult to produce. Imitation can be used as a first step in programs to teach specific language targets (Connell, 1987a, 1987b) or as a correction procedure when the child fails to respond or responds incorrectly. The procedure has been used successfully with several types of LI. By monitoring a child’s progress, an SLP can provide varied cues, including partial models and/or delayed imitation. A child may respond also to questions for which an SLP has modeled the answers. Initially, the modeled answer may follow the question, but this format can be altered so that the answer precedes the question, is given partially, or precedes the question by increasingly longer periods of time. An SLP might also model the type of response desired, although not the exact one. Although the modeling procedure seems stilted in writing, it can be applied very flexibly and works well with groups of children. In small groups, children who have acquired a certain target can serve as models for those who have not. By varying turns, an SLP can ensure that sufficient models are


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provided for different children. In a reversal of roles, the SLP can serve as a model for a child, while the child cues the SLP. Modeling alone may be less effective than other, more structured methods (Cole & Dale, 1986; Connell, 1987a). Whereas modeling is effective in changing the behavior of children developing typically, it is less effective than imitation with children with LI (Connell, 1987a). More structured approaches include imitation and elicitation in the form of fill-ins.

DI R ECT LI NG U ISTIC CU ES Linguistic cues for certain targets can be direct or indirect. Direct elicitation techniques might include the following target questions: To elicit . . . Verbs Noun subjects Noun objects Adverbs or adverbial phrases Adjectives or adjectival phrases

Specific words

Use . . . “What is he doing (are you doing)?” Use any tense. A benefit is that the question contains the target tense. “Who/what is verbing?” Again, the tense can be altered for the situation. “What is he/she verbing?” Tense can be altered for the situation. Obviously, verbs that do not take objects should not be used. “When/where/how is he/she verbing?” Tense can be altered. “How” questions can be used also to elicit process answers, as in “How did you make the airplane?” “Which one . . . ?” Tense can be altered. There should be an obvious contrast between choices for the response, such as big and little. These differences might be noted prior to questioning. Responses of a particular type can be modeled, as in “Which one ate the cookie, the littlest bear, the middle-size bear, or the biggest bear?” To keep the child from responding, “That one,” the SLP may want to cover the child’s eyes or use some barrier. Completion sentences, as in “She is playing in the _____.” Rising intonation after the last spoken word will signal the child to respond. If the SLP plays dumb or acts forgetful, the child’s behavior makes more sense conversationally.

Substitution requests also can be used. For example, pronouns can be substituted for old information. The facilitator might make a statement, such as giving one descriptor (“The dog is little”), and then ask the child to make a comment (“What can you tell me about the dog?”). This procedure also can take the form of a guessing game, as in “Is the dog little? Well, if the dog isn’t little, what can we say?” Of course, our goal is “He is . . .” Although these linguistic cues are conversational in nature, they will seem very nonconversational if used in nonlinguistic contexts in which they make no sense pragmatically. Questions should be used when the facilitator really desires the answer and when the child is interested in the topic of discussion. An SLP can model a response prior to asking the child a question, as mentioned previously. For example, “I think I want the yellow one. What about you?” This type of cue is more likely to elicit a longer utterance and is more conversational in tone. The goal is a sentence of similar construction. If you ask, “which do you want?” you may get “Red” in reply.

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One variation of the direct linguistic cue is a mand model (Hart, 1985; Rogers-Warren & Warren, 1985; Warren & Kaiser, 1986a, 1986b). This technique has been used effectively with preschoolers and with children with SLI (Olswang & Bain, 1991). This procedure follows a routine that is established prior to beginning any activity. The routine serves as a chain in which one stimulus cues the next. The mand-model approach usually is used for teaching new language features. In this approach, access to desired items is through an adult, who determines the criterion for acceptability. In this way, the adult, not the object, becomes the stimulus for talking. According to this procedure, “it is likely to be not so much what the teachers do—the forms of language they model— as the interactional context in which the adults’ models occur that facilitates children’s progress in language learning” (Hart, 1985, p. 81). In the four-step mand-model training sequence, an adult first attracts a child’s attention by providing a variety of attractive materials. This inducement may not be necessary if the child already displays an interest. Thus, the adult establishes joint attention with the child. In the second step, after the child has expressed interest, the adult (de)mands, “Tell me about this,” or, “Tell me what you want,” requesting a behavior trained previously. If there is no response, the adult moves to step three and prompts a response or provides a model to be imitated. In step four, the adult praises the child for an appropriate response and gives the child the desired item. Preschool peers can be trained to use the mand-model technique effectively (Venn, Wolery, Fleming, DeCesare, Morris, & Cuffs, 1993). Production has generalized to unprompted productions. I N DI R ECT LI NG U ISTIC CU ES Indirect linguistic cues are more conversational and situational in nature. For example, when attempting to elicit questions, the SLP might use unfamiliar objects hidden in boxes to set the nonlinguistic context. Beginning with “Boy, is this neat,” the SLP peeks into the box. An exchange might continue as follows: Child: What’s in there? Facilitator: This. (Takes the object out. Waits.) Child: What is it? Facilitator: A flibbity-jibbit. It does everything. Child: What it do? It is easy to see the interplay of nonlinguistic and linguistic cuing. Another indirect linguistic technique requires the SLP or language facilitator to make purposefully wrong statements. A child’s clothing can serve as the focus of this conversation, a technique I have dubbed “the emperor’s new clothes.” Facilitator: (Touching child’s red sweater) What a nice blue blouse. Child: This no blue blouse. In both examples, the child has given a final response that may be something less than what is desired. The SLP now can respond and begin to shape the child’s previous utterance into an acceptable form. These examples are only a very few of many indirect techniques. Others examples are listed in Appendix D. The possibilities are only limited by your imagination.


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CONTI NG E NCI ES Conversational consequences can be divided roughly into those that do not require a child’s response and those that do. Each type provides some feedback to the child, and each differs with the functioning level and degree of learning exhibited by the child. Contingencies Requiring No Response Contingencies that require no response from a child are nonevaluative or accepting in nature and can be used to increase correct production or highlight incorrect production for self-correction. When a child initiates or responds to some cue, the facilitator focuses full attention on the child, creating joint focus on the child’s topic. Because the child has established the topic, it now acts as a reinforcer for the child and can be used to modify the child’s language. Techniques used to modify the child’s response include fulfilling the intention, use of a continuant, imitation, expansion, extension and expiation, breakdowns and buildups, and recast sentences. By fulfilling the intention of a child’s utterance, such as handing the child a requested item, the facilitator signals the child that the message was acceptable as received. No verbal response is required. A continuant is a signal that a message has been received and acknowledged. These signals usually consist of head nods or verbalizations, such as “uh-huh” and “okay.” Continuants fill a speaker’s turn by agreeing with the previous utterance. In imitation, the facilitator repeats a child’s utterance in whole or in part but makes no evaluative remarks. Rising intonation, signifying a question, is not present. Again, this behavior acknowledges the child’s previous utterance. Imitation is especially helpful to the child when correctly produced features of interest are emphasized (“She is riding the bike”). Imitations might be preceded also by phrases such as That’s right (“That’s right, she is riding the bike”). In contrast to imitation, expansion or recast/expansion is a more mature, or more correct, version of the child’s utterance that maintains the child’s word order, for example: Child: It got stolen by the crook. Facilitator: Uh-huh, it was stolen by the crook. The use of expansion as a teaching tool is very limited for children functioning above about 30 months of age. In a variation of expansion, the SLP can prompt the child to imitate the expansion, although such requests disrupt the flow of conversation. A more appropriate variety of expansion for older children is a reformulation in which two or more child utterances are combined into one utterance that includes the concepts of each, as in the following: Child: The dog bit the man. The man ran away. Facilitator: Oh, the dog bit the man, who then ran away. At low levels of child grammatical production, the use of expansion and cloze, or fill-in-the-blank, procedures by adults produces more responses, more interpretations, and more syntactically complex utterances by children than does a question-and-answer procedure (Bradshaw, Hoffman, & Norris, 1998).

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For older children, extension is a more appropriate response. Extension is a reply to the content of the child’s utterance that provides additional information on the topic, as in the following: Child: It got stolen by the crook. Facilitator: Oh, I wonder if the crook stole anything else. Much of our behavior in conversations consists of replies to the content of the other speaker, and these comments can be used effectively regardless of the age or functioning level of the child. Extensions signal the child that the facilitator is attentive and interested. Breakdowns and buildups consist of dividing the child’s utterances into shorter units and then combining them and expanding on the child’s original utterance. The purpose is to help the child understand intrasentential relationships. I use this strategy as my great-great-uncle used to do to aid the processing of information, mulling it over before commenting. Child: It got stolen by the crook. Facilitator: (Emotional, disbelieving) It was. (Hmmm) It was stolen. Stolen by the crook. (Disgusted) By the crook. (Finally) It was stolen by the crook. This strategy works well, especially if the SLP or facilitator plays dumb or uses a silly puppet who just does not seem to get things right. The child may shake his head or say,“Uh-huh,” in agreement between the facilitator’s utterances. Finally, recast sentences maintain the child’s meaning or the relations while modifying the structure, and they immediately follow the child’s utterance. Recasts repeat at least one of the major lexical elements while modifying other parts of the utterance. For example, Child: He not eat. Adult: The dog is not eating his food. Is he hungry? Child: Not hungry. Adult: The dog is not eating his food. He is not hungry. Is the cat eating? Child: Uh-huh. Adult: The cat is eating his food. The dog is not eating his food. We may be splitting hairs in this example because these types of recast are very close to expansions. Sentences can also be recast in another form: Child: It got stolen by the crook. Facilitator: Was it stolen by the crook? OR It was stolen by the crook? OR The crook stole it. OR Did the crook steal it?


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These sentences can be recast in whatever form the SLP has targeted, although comments are easier for children than question forms. Note that even though the form is changed the relations are not: crooksteal-it. Although children with SLI can benefit from the use of them, recasts must be produced in much greater quantity than found in typical conversation to be of value (Proctor-Williams, Fey, & Frome Loeb, 2001). If the child says little, the SLP can recast his or her own utterances. If the child will not stop talking, the SLP can interrupt with “yeah” or “uh-huh” and insert a recast sentence. The effectiveness of recasts is based on four assumptions (Fey et al., 2003): easy for the child to attend, because the recast sentence is based on the child’s utterance. • ItIt isis easy the child to comprehend, because the recast sentence is similar to the child’s sentence. • It is easy for for the child to notice the change, because the recast sentence differs from the child’s sen• tence primarily in the use of the targeted feature. It is easy for the • in context. child to understand underlying relationships, because the recast sentence occurs Conversational Contingencies Requiring a Response Conversational contingencies that require a response are used when a child is able to produce the target reliably but has failed to do so in conversation or has produced the target inaccurately in conversation. A skilled use of both nonlinguistic and linguistic contextual cues should set the stage for production of the target in a situation in which it makes good pragmatic sense. As a fully participating conversational partner, the child has an interest in the conversation and in his or her own utterance. Thus, the child is motivated to modify production in order to maintain the conversation and receive the adult’s attention. Most of these contingencies note the child’s error or require the child to find the error, and request that the child produce the target more correctly. A second contingency type requests repetition or a correct or expanded utterance to strengthen correct production. A hierarchy of both types, ranging from contingencies that provide maximum input to the child to those that provide the minimal, would be correction model/request, incomplete correction model/request, reduced error repetition/request, error repetition/request, self-correction request, contingent query, repetition request, expansion request, and turnabouts. In a correction model/request, the facilitator repeats the child’s entire utterance, adding or correcting the target that was omitted or produced incorrectly, for example: Child: I builded a big tower out of blocks. Facilitator: I built a big tower out of blocks. Now you say it. (or “Tell me that again.”) The child is requested gently to repeat the facilitator’s model. Note that the error has been corrected for the child. Initially, the target may be emphasized to aid the child in locating the corrected unit. Later training might restate the child’s utterance as a question, as in, “You built a big tower out of blocks?” Obviously, there are some language features such as omitting am, that cannot be modeled in a question, such as you are . . .

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Because the entire utterance is desired in the child’s response, the facilitator should act confused to maintain the conversational nature of the interaction. Facilitator: You built a tower out of big blocks? No, you built a big tower out of blocks? Oh, I’m confused, tell me again. In a correction model/request, the child is provided with a complete or only slightly altered model of the correct utterance. The facilitator should require the child to produce correctly only those units that are currently targeted for intervention. It is difficult for some facilitators to reinforce utterances even when they contain errors, as in the following example: Child: I builted the most biggest tower out of blocks. Facilitator: You built the biggest tower out of blocks? Child: Yeah, I built the most biggest tower out of blocks. Facilitator: Uh-huh, how big was it? OR Yeah? What kind of blocks did you use? OR Oh! Where is the tower now? Note that the facilitator ignored “most biggest.” A conversational approach requires the language facilitator to remain focused on the target and on the hierarchy of teaching strategies being used. In contrast to a correction model/request, an incomplete correction model/request provides only the corrected target. The child must provide the rest of the utterance, as follows: Child: I builded a big tower with blocks. Facilitator: Built. Child: I built a big tower with blocks. Initially, the child will need a cue to repeat the utterance with the corrected target. As the child begins to exhibit some success at self-correcting, the facilitator can offer choice-making: “Is it builded or built?” The facilitator must be careful to use this form occasionally when the child’s initial utterance is correct as well as when it is incorrect. Otherwise, the child will recognize that the question is only used when he makes an error. In addition, the location of the correct answer should vary so that the child does not develop a strategy of always picking the first or second of the pair choice. Once the child has learned the target reliably within more structured situations, the language facilitator can use other techniques that require the child to supply the missing or correct target. With reduced error repetition/request, the facilitator repeats only the incorrect structure with rising intonation, thus forming a question. This contingency informs the child that the language unit in question is incorrect and must be corrected, for example: Child: I builded a big tower with blocks. Facilitator: Builded? Child: Built.


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The facilitator’s question is more conversational than the cue found in correction model/requests and is less disruptive to the flow of conversation. If the child fails to recognize the error, the facilitator can provide a corrected model by using an incomplete correction model/request. With error repetition/request, the facilitator repeats the entire utterance with rising intonation. The child must locate the error or omission and correct it, as in the following: Child: I builded a big tower with blocks. Facilitator: I builded a big tower with blocks? The emphasis on the error can be increased or decreased as needed. For example, increased emphasis might be used to aid the child in finding the error. If this technique is unsuccessful, the facilitator might provide a reduced error repetition/request. Once the child’s target knowledge is reasonably stable, the facilitator can use the error repetition/request even when the child is correct. This procedure helps children scan their productions spontaneously and to self-correct. A self-correction request does not provide the child with a repetition of the previous utterance. Instead, the facilitator asks the child to consider the correctness of that utterance from memory, for example, “Is/was that right/correct?” and “Did you say that correctly?” If the child is unsure, the facilitator can provide an error repetition/request. In contrast to the somewhat stilted tone of the self-correction request, the contingent query is very conversational. It is concerned more with comprehension of the message being sent than with specific targets. Nonetheless, this technique can be used effectively to signal the child that something may be amiss with the production. The child is left to scan recent memory to determine where communication breakdown occurred. Use of contingent queries should be limited because they can disrupt communication and frustrate the speaker who is continually asked to repeat. Young school-age children dislike having to repeat more than once or twice. Contingent queries may be specific or general, depending on the abilities of the child. In response to the sentence “I builded a big tower with blocks,” the facilitator might respond, “What did you do with blocks?” “What did you do?” or simply, “What?” If the child falsely assumes that his or her production was correct and merely repeats the error or omission, the facilitator might use a selfcorrection request. Correct productions of the target can be strengthened by asking the child to repeat. With a repetition request, the facilitator simply says, “Tell me that again,” or, “Could you say that again?” This technique also can be used conversationally, implying that the listener missed some portion of the transmission, not that the transmission was in error. If the child produces the target correctly but in a smaller unit than desired, such as a one-word response following a reduced error repetition/request, the facilitator can use an expansion request. The typical cue “Tell me the whole thing” is not conversational in tone. It is better for the facilitator to fake confusion and ask for a total restatement, as in the following example: Facilitator: Built? What was built? Who built it? I get so confused. You better tell me again. The advantages of using this routine to elicit language from children were discussed previously.

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Turnabouts may be more effective than repetition requests and are more conversational in nature. In a turnabout, the facilitator acknowledges the child’s utterance or comments and then asks for more, as in “Uh-huh, and then what did you do?” or “Wow, what will you do next?” or “That sounds like fun; what happened then?” The turnabout technique has been taught successfully to high school peers and parents and has been used effectively in conversation with children with LI (Hunt, Alwell, & Goetz, 1988, 1991). This partner-as-facilitator strategy reportedly can improve conversation skills significantly. The wh- questions used in turnabouts should be of a topic-continuing nature and thus support the child’s efforts to maintain the topic (P. Yoder, Davies, et al., 1994). This style of responding is especially helpful to preschool children and children with LI. Several relational terms also may be used in open-ended utterances to aid the child in providing more information of a specific nature. For example, the facilitator might repeat the child’s utterance with the addition of but to elicit contrary or adversative information, or and to elicit complementary information. Child: We played games at the party. Facilitator: What fun. You played games at the party and . . . Child: And we had cake and ice cream. Other types of relationships and terms are as follows (J. Norris & Hoffman, 1990b, pp. 78–79): Temporal Causal Adversative Conditional Spatial

and then, first, next, before, after, when, while because, so, so that, in order to but, except, however, except that if, unless, or, in case in, on, next to, between, etc.

The conversational contingencies just discussed can be arranged in a hierarchy similar to that in Table 10.2. This arrangement will differ with the language unit being targeted. The facilitator who is familiar with this hierarchy can respond to the child’s utterances in a top-down manner that enhances language stimulation and facilitates language learning.

Top-Down Teaching The methods presented so far are helpful no matter what method of intervention used by an SLP. It is in the arrangement of these techniques that everything changes. A functional approach is one that uses conversation whenever possible as the milieu for instruction. Employing a top-down intervention model, an SLP helps a child repair conversational errors as they occur within context. Initially, the SLP selects targets based on the child’s needs and activities and topics of conversation based on the child’s interests and experience. Placing intervention within everyday routines or play is ideal. By manipulating both the nonlinguistic and linguistic context, the SLP can elicit the targeted language feature and then provide just enough input to aid the child’s production. The amount of input needed by the child depends on the child’s ability and will differ across children.


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TABLE 10.2

Hierarchy of Conversational Contingencies

For the examples, the child’s utterance is “I sawed two puppies.” The facilitator should use the contingency farthest down on the list that ensures the child’s success with minimal input. Facilitator Input

Conversational Contingency



Correction model/Request

I saw two puppies. Can you tell me again? (The cue to say it again is optional, unless the child does not repeat spontaneously.)

Incomplete correction model/ Request

Saw. Can you tell me again? (Again the cue is optional.)


Is it saw or sawed?


Reduced error repetition/Request


Error repetition/Request

I sawed two puppies?


Was that right?

Contingent query

I didn’t understand you. Say it again, please. (Other options include Huh? and What? or, in this example, What did you do?)

Expansion request

Tell me the whole thing again.

*Repetition request

Tell me again.


You did? I love puppies. What did they look like?

*Used with complete, correct responses.

Let’s assume that a child is working on irregular past tense and the SLP is inquiring about the past weekend, specifically what the child saw, ate, drank, and so on. In this case, the child can self-repair but requires that the error be highlighted in order to do so. Note in the following example how the child needs more assistance than first assumed by the SLP. It is also important to note that the SLP does not correct the error for the child. Supplying the correct response builds dependence on this type of help and does not foster independence. Example of hierarchy in use: Child: I sawed two puppies. Partner: Was that right? (Self-correction request) Child: Uh-huh. Partner: I sawed two puppies? (Error repetition/request) Child: Yeah. Partner: Sawed? (Reduced error repetition request) Child: Saw. I saw two puppies. Partner: Uh-huh, tell me again. (Repetition request) Child: I saw two puppies. Partner: I think I love puppies more than kittens. Where did you see them? (Turnabout)

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When the child gives the correct response, the SLP does not respond with that tired old “Good talking!” Instead, he or she strengthens the correct response by asking for a repetition, then replies conversationally and uses a turnabout to elicit the next response. Let’s eavesdrop some more. Child: At the pet store. Partner: I’m confused. What happened? Child: I saw the puppies at the pet store? Partner: Oh, you saw them at the pet store. Pet stores are fun. When did you go? Child: I goed on Saturday. Partner: Was that right? Child: I went on Saturday. Partner: Oh, you went to the pet store on Saturday and saw the two puppies. Did you go alone? Notice how each response by the SLP tries to elicit another that includes use of the target, the irregular past tense. The functional approach to intervention can be challenging for an SLP at first. Once she or he begins to think in a new way, and with practice, functional teaching becomes second nature—just simply the way the SLP talks with children. The intervention approach can be used in almost any interaction with a child, thus giving an SLP ultimate flexibility.

Conclusion Both the nonlinguistic and linguistic contexts can be manipulated by an SLP and other language facilitators to teach language to a child and to encourage use of structures recently acquired. By using the various techniques described in this chapter, facilitators can maximize interactions with child with LI. Although it would be ideal if facilitators used the full range of techniques, even the adaptation of some would help make learning more conversational in nature.

11 chapter

Specific Intervention Techniques

Chapter 11

Specific Intervention Techniques



number of training techniques effectively teach the use of linguistic features to children with LI. The success of intervention varies with the particular linguistic feature trained, the manner and duration of the training, and the characteristics of the individual child (Leonard, 1981). Prior to beginning intervention, an SLP should examine all deficit areas for a given child and apply a “What’s the point?” criterion (Lilius, personal communication, 1993). In short, an SLP is concerned with the importance of individual deficits on a child’s overall communication. Each deficit should be evaluated to the extent that it contributes to a child’s communicative functioning. Deficits that greatly affect functioning should be targeted first for intervention. Those that do not affect overall communication fail the “What’s the point?” test. It is important that an SLP consider generalization at the beginning of intervention and make crucial training decisions on the basis of generalization to the everyday environment. At least a portion of each lesson should involve the conversational context. Intervention that focuses solely on linguistic form can result in limited progress and lack of generalization (Goetz & Sailor, 1988; Halle, 1988). Preferable are specific situations in which language form skills are necessary, such as using the telephone or play (Mire & Chisholm, 1990). In general, in this chapter we discuss a developmental hierarchy for intervention, modified where appropriate by sound teaching principles research and evidence-based practice. It is important to remember that development is a gradual process with much overlap between language features. Development is also not “domain-specific” (Kamhi & Nelson, 1988). Rather, changes in one area of language can affect other areas. When possible, apply the functional approach explained throughout this text. Use it as your overall model. At all levels of instruction, some elements of the functional intervention model can be used. Intervention should be fun and challenging, using real conversational exchanges between the child and partners wherever possible. Thus, both partners are involved actively in the process. In this chapter we explore some proven and some promising techniques for language intervention. I have attempted to include the best evidence-based practices. For clarity, I have divided the chapter into four aspects of language: pragmatics, semantics, syntax, and morphology. We discuss hierarchies for training and techniques that lend themselves well to each area. The final portions of the chapter deal with the special needs of children from CLD backgrounds and the clinical application of computers. The best intervention addresses language holistically so that a child can experience newly acquired language as it is used in communication. Some SLPs accomplish this goal by targeting skills in more than one area of language or by using a stage approach in which a few training targets from a stage of development are targeted simultaneously. Suggested activities are presented in Appendix E.

Pragmatics Traditional language intervention goals are usually product rather than process oriented (Wilkinson & Milosky, 1987). In other words, language forms are targeted, whereas language use is tangential. Although a theoretical shift has occurred toward pragmatic models of language, many intervention programs continue to emphasize syntax and semantics. In general, communicative context is used only to create fun or as an afterthought relative to generalization. Children can acquire very complex forms without totally comprehending them. It is essential, however, that they understand the functional qualities or uses of the forms being taught (Snow & Goldfield, 1983). We might do better to teach the appropriate contexts in which to use linguistic forms.


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When appropriate, linguistic forms can and should be targeted within a functional context. For example, an SLP might teach requesting as a function of the goal of gaining information, action, or materials. The SLP can help children identify the linguistic form that goes with each goal. Subsequently, he or she may teach alternative forms for such requests. Through role-playing and the use of videotaped interactions, an SLP can teach a child to identify situations in which the desired information, action, or material was requested inadequately, inaccurately, or inappropriately. The SLP also can train either repairs and reattempts or requests for clarification. Likewise, he or she can help the child to identify the requested goal of another speaker and to respond appropriately. An SLP may directly target a number of pragmatic skills within a single lesson and should use many everyday events and play activities to teach pragmatic skills. For example, telephone conversations teach acknowledgment of the interaction, conversational opening and closing, topic maintenance, and referential communication. The use of situationals and different voices on the other end of the phone can help a child adapt to differing situations scenarios. For example, by pretending that he or she is lost, an SLP can teach requesting and giving assistance and information, roles, and following directions. Construction toys used to copy a model, such as Legos, clay, and Play-Doh, or construction paper can teach requesting assistance, referential communication, giving and following directions, and topic maintenance. More difficult tasks will require requesting assistance. Several children’s stories can be enacted to help a child learn roles. The use of puppets or dolls or different costumes also will aid the learning of role taking. Finally, an SLP can use any number of activities for referential communication. Children can describe objects seen in books, on computers, or through toy periscopes, felt in paper bags, or hidden. Such activities as I Spy and Twenty Questions also aid referential communication growth and foster requesting and giving information. Effective intervention must enhance language and social skills while generalizing to authentic interactions (Timler, Vogler-Elias, & McGill, 2007). Although more structured clinician-centered intervention methods may be required for some children, generalization to a child’s everyday environment is key to success. I NTE NTIONS Children select and acquire utterances that are communicatively most useful. In training, an SLP is concerned with the breadth of intentions that a child is able to express. The following section addresses the training of several intentions. In Chapter 12, some methods to be used in the classroom are discussed. Appendix D also provides several indirect linguistic cues useful for eliciting different functions. Calling for Attention Calling for someone’s attention requires the presence of a person whose attention the child seeks or who is essential to completion of a task. In general, children seek attention from adults who provide it. Within intervention, facilitators might give a child an object and ask him or her to take it to an adult who, for the purpose of training, initially ignores the child. The child also might be asked to relay a message to someone else. Facilitators should attend to a child as soon as the child requests attention. If the child continually demands attention or uses inappropriate behavior to get attention, the facilitator will have to set

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some limits, such as only responding in certain situations and never responding to inappropriate behavior. The form of attention-requesting is usually a child calling a facilitator by name or gaining attention by some other means, such as tapping the listener’s shoulder, moving into the visual field of the listener, leaning in the direction of the listener, or using eye contact. The child also may specify how the facilitator should respond by making a request. These sequences are easy to train within a variety of activities. Requests for Action Requests for action can be trained at mealtime, within small group projects, or during almost any physically challenging task. A facilitator will need to design situations in which children require assistance to complete a task. To encourage requesting, a facilitator can use games in which children must solve problems. Tasks also may be sabotaged by a facilitator (see Table 10.1). In requests for actions, attention is gained first, and the form of the utterance is interrogative or imperative. Requests for Information Children with LI often do not see other persons as sources of information and may produce few such requests of this type. Although the environment can be manipulated to encourage requests for objects and actions, it is not as easy to encourage or increase a child’s need and desire to seek information. Requests for information require that a facilitator omit essential information for some novel or unfamiliar task, such as an art project, a new game, or some challenging academic task. Objects unknown to a child may be introduced without being named or their purpose explained. A child can be prodded gently to ask questions if asking does not occur spontaneously. A child must recognize both the need for this information and that another person possesses the knowledge. Recognition of need is often the most difficult aspect of this training. Confrontational naming tasks, with objects known and unknown to a child, may encourage initial requesting for information. The form of requests for information is either a wh- or yes/no interrogative with rising intonation, as in “what’s that?” or “Is that a marker?” A facilitator also might encourage the child to ask questions by questioning him or her about other people’s feelings or actions of which the child has little knowledge. The child then can be cued with “Why don’t you ask (name)?” This tactic can be used with naming tasks as well, as in “See if Juan knows what this is.” A child should be expected to ask questions that reflect the forms he or she is capable of producing. The facilitator’s verbal responses discussed in Chapter 10 can be used to help the child modify incorrect, inappropriate, or immature responses or learn new ones. Requests for Objects A facilitator can easily train requests for objects within art tasks, group projects, snacktime, job training, or daily living skills training, such as dressing and hygiene. It is essential that a child actually desire the object he or she is to request and that the facilitator can provide it. A facilitator can change the environment to increase both the opportunities for requesting and the behaviors that direct a child’s attention to these opportunities. Many situations, especially those with groups of children, provide an opportunity for overlooking a child’s turn, thus encouraging requesting. Of particular importance is a coordinated program designed to teach requesting for use in the


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TABLE 11.1

Guidelines for Caregiver Elicitation of Requests for Objects

Make statements throughout the day about objects that the child might prefer. Wait for a response. Use elicitation behaviors to accompany high-interest activities and play. These behaviors include the following: Modeling with an imitative prompt. Facilitator provides a model of a request and asks the child to imitate.

Direct questioning. Facilitator asks, “What do you want?” or “What do you need?” Indirect modeling. Facilitator provides a partial model followed by an indirect elicitation request, such as, “If you want more X, let me know (or, “ask me for it”) or, “Would you like to X or Y?” Obstacle presentation. Facilitator requests that the child accomplish some task but provides an obstacle to accomplishment. “Please get me the chalk over there.” (There is no chalk.) “Pour everyone some juice.” (The container is empty.)

General statement. Facilitator makes a verbal comment about some activity or object that the child might want to request. The facilitator entices the child. “We could play Candyland if you want to.” “I have some Play-Doh on that high shelf.” Set up specific situations to elicit requesting. Provide direct and indirect models as often as possible without requiring the child to imitate. Provide a model at appropriate times when the child appears to need assistance or is looking quizzical. Have the child attempt difficult tasks in which help is occasionally needed. Respond immediately and naturally to any verbal request. Source: Adapted from Olswang, Kriegsmann, & Mastergeorge (1982).

everyday environment by approximating that environment and by training those within that to model and elicit requests. Table 11.1 includes general guidelines for caregiver elicitation techniques. Expression of this intention usually begins with eye contact or some attention-getting behavior, such as calling environment a name. The form, usually accompanied by a reaching gesture, is interrogative (“can I have . . . ?”) or imperative (“give me . . . ”) and specifies the desired object. An SLP can elicit denials by giving the child something other than what he or she requested or by giving the child something undesirable. The child can reject either an action or proposal. The speaker uses emphatic stress, and the utterance is in a negative form. Responding to Requests Responses may take the form of an answer to a question or a reply to a remark. These forms are very different and require different skills. In responding to questions, children must recognize that they possess the answer and that they are required to reply. Questions require answers from the other partner. Initial training should disre-

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gard the correctness of the answer in favor of reinforcing answering in general. At this stage, teaching wh- question responses should reflect the appropriateness-before-accuracy pattern (Parnell et al., 1986). Responding with an incorrect answer is preferred over no answer at all. In a situation in which a facilitator asks about objects known to a child, it is fairly certain that the child will give the appropriate answer, although it might be inaccurate. The information requested can expand gradually to conform to the child’s ability to respond. Appropriate responses not only include answers in reply to questions but involve the correct emotional level of responding. Some children with LI have difficulty identifying the emotions of others and of themselves and placing these in a form of expression. We can teach awareness and expression through a three-step intervention model (Way, Yelsma, et al., 2007): 1. Connecting physical experience and emotions 2. Increasing awareness of own emotional state 3. Connecting emotion to expression Activities within each step are presented in Table 11.2. Replying to a request is more difficult to teach than answering because a response is expected but not required. A child’s response may be in the form of nonlinguistic compliance or a linguistic response. Children’s comprehension of different requests will vary with age (Ervin-Tripp, 1977). Table 5.5 contains the ages at which different types of requests are understood. A child can be helped to recognize the need to reply by physical signs from the SLP, such as a head nod, or the passing of an object to signal “It’s your turn.” A child’s ability to reply may be hindered by an inability to determine the topic or to formulate a response. A facilitator may enhance linguistic processing by having the child repeat the request. Over time, the facilitator can modify this procedure to whispered imitation, mouthing, and silent repetition until the process is internalized by the child. In this way, children can be helped to identify important information in requests and in formulating responses. Statements Show-and-tell, discussions, and current-event activities help children state information. During discussions of high-interest topics, such as, holidays, pets, and family events for children or dating, friends, and competitive games for adolescents, a facilitator can encourage offering of opinions. A facilitator also can use mock radio and television broadcasts. With a little cutting and some paint, he or she can convert a large appliance box into a console television from within which children can deliver daily newscasts of information. A facilitator may either know the information a child is sharing or not. In the first instance, the child is recalling a shared event; in the latter, the child is presenting new information and can assume that the facilitator has very limited information. Each situation has different informational needs and requires some presuppositional skill to determine the necessary amount of information to convey. Children can be taught how much information to include (see under Presupposition heading). The form is declarative. Initially, the child must secure the listener’s attention and state the discussion topic. Statements can be expanded into narratives whose purpose is also to convey information.


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TABLE 11.2

Teaching Emotional Awareness and Expression

Connecting Physical Experience and Emotions

• •

Bodywork, such as recognizing one’s heartbeat, sweating, flushing, or a stomachache, can help a child turn his or her attention internally. Connecting physical states to specific feelings and learning methods to calm oneself when feeling anxious or upset.

Increasing Awareness of Own Emotional State

• • • • •

Drawing the child’s attention to the important features of expression, then modeling language to express those feelings. SLPs might observe and comment on facial expressions, body expressions, vocal affect, and labels or words in affective experiences. Role-playing various feelings. Identifying feelings of characters in stories, videos, or photos; or using art therapy. Using feelings strips on which is the unfinished sentence, “I feel . . . ” into which children can insert feelings faces to describe their feelings. In this way, children are taught physical cues for different feelings at the same time as they learn to become aware of their own. Identify single feelings and then learn to recognize multiple feelings at a particular moment. Begin with primary emotions such as joy, sadness, anger, fear, disgust, and interest, and then progress to more sophisticated complex emotions that require self-reflection, such as empathy, sympathy, guilt, envy, shame, regret, and pride.

Connecting Emotion to Expression

• • •

Drawing pictures to express feelings nonverbally in preparation for addressing them verbally. Expressing emotion through role playing, pretend play, and acting out dramas. Creating a skit from an index card listing multiple feelings, and then having other children guess the feelings being portrayed. • Acting out stories from books, TV shows, and movies. • Reading and listening to narratives and making sense of character perspectives in the context of story events. SLPs can use questions that probe linguistic and socioemotional awareness, questions that guide students to reflect on feelings and organize these ideas using language to describe, report, predict, and interpret feelings and motivations. • Oral and written storytelling to share personal narratives while developing integrated language skills and expressiveness. Source: Denham & Burton (1996), Greenberg & Kusché (1993), Hyter, Atchison, & Blashill (2006).

CONVE R SATIONAL AB I LITI ES More than other areas of language intervention, the training of conversational abilities requires the use of actual conversational situations. Ritualized communication that interferes with interpersonal communication, such as echolalia, can be modified gradually into acceptable and conventional routines, such as greetings, conversational initiations, and requests for repair (Lord, 1988; Lord & Magill, 1988;

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Magill, 1986). For children with Asperger’s syndrome, high-functioning autism, or other social interactional difficulties, the following conversational goals seem appropriate (Kline & Volkmar, 2000): of verbal and nonverbal communication, including initiating a conversation and • Conventions selecting appropriate topics. awareness and social problem solving, including perceiving verbal and nonverbal cues and • Social making inferences. and management, including ability to participate in diverse communication activ• Self-evaluation ities and to control one’s own behavior. Social routines can be memorized and practiced in different situations that help a child become more flexible in their use. Variations can be taught through different facilitators and situations. For example, one does not offer to shake hands when the potential partner has her or his arms full (Lord, 1988). If nothing else is accomplished in training, a child learns appropriate entry into conversations (Prizant & Wetherby, 1985). For adolescents with LI, the give-and-take of conversation and the important social interactions of peers are often extremely difficult. The result can be social isolation. This can be hastened by the peer group’s negative perceptions of a child with LI. In a study of TD adolescents, several behaviors that may or may not be present in teens with LI occur frequently (Turkstra, Ciccia, & Seaton, 2003). These include at a conversational partner, especially when listening. • Looking Nodding and showing neutral and positive facial expression. • Responding verbally to acknowledge understanding (Uh-huh, Yeah). • Giving contingent responses. • You may recall that contingent responses may be semantically contingent (on-topic) and/or pragmatically contingent (appropriate). These four behaviors suggest targets for helping children with LI interact more appropriately. While only limited research data exist, they suggest intervention methods that may work for some teens (Brinton, Robinson, & Fujiki, 2004). A two-step intervention program could (1) help youth with LI think of conversation as a reciprocal endeavor that requires adjustment for one’s partner and (2) provide interactive strategies to solicit and act on conversational contributions by others. Intervention can occur within structured, conversation-focused, small-group activities (Nippold, 2000). The atmosphere should be positive with plenty of opportunity for success. Within this context, the SLP models appropriate responses and this modeling is, followed by teen practice, then peer analysis and feedback with the use of video recordings and small-group discussion (Hess & Fairchild, 1988). Scripted sequences and role-play can be very helpful. Video clips and guided observation and comment can be used to aid an adolescent to comment on the nature of exchanges, feelings and thoughts of participants, and interpretation of reactions. The bulk of the time, however, should focus on interactive strategies, moving from highly structured situations in which turns and topics are controlled to more free-flowing conversations. Clients can be trained in variations of comment-question, in which they make a contingent comment on their partner’s utterance and then ask a related question. Listening and comprehension skills can also be


Part 3 Intervention

enhanced. From here, additional interactional techniques, such as how to ask someone’s opinion or how to draw listeners into the conversation, can be taught. Entering a Conversation Although entering an interaction can be a formidable challenge to children with LI, kindergarten children can be taught play-entry strategies through modeling and prompting by an adult (Selber Beilinson & Olswang, 2003). Four nonverbal “low-risk” strategies can be taught initially through modeling and visual picture prompts: over to your friend. • Walk Watch • Get a toyyourlikefriend. the one your friend is using. • Do the same thing as your friend. • A fifth, “high risk” strategy includes verbal initiation. In modeling verbal initiation, the classroom teacher, aide, or SLP helps a child select a toy similar to that of another child and says to the second child, “We’re building with blocks just like you.” This can be an opening for the other child to respond by asking the child to join. A more direct model might include telling a child what to say. When a child can successfully imitate the opening behavior, the adult gradually reduces the model and tries to prompt it through toys and picture and verbal prompts. These are also reduced until a child can initiate spontaneously. Other strategies might include interpreting (I think Mohammed wants you to play with him), giving suggestions (Maybe Kwanzi would like to see what you made), referring to a peer (Maybe Alex can help you hold the paper while you glue it), and commenting on similarities (Jin is making a costume too. Tell him about yours.) (Weitzman & Greenberg, 2002). Presupposition A speaker’s semantic decisions are based on her or his knowledge of the referents (the thing to which words refer) and the situation and on presuppositions, or social knowledge of a listener’s needs. A speaker needs to provide information that is as unambiguous as possible. In other words, the speaker and the listener need to share the same linguistic context. Often, children with LI are unaware of their audience’s needs (Bliss, 1992). With maturity, children developing typically are increasingly able to perspective-take, the greatest growth occurring in middle childhood. In contrast, children with LI seem to improve little with age. Breakdown may occur in social-cognitive processes and/or linguistic production (Bliss, 1992). Significant improvement can occur, however, from training speakers to be aware of listener needs. The two aspects of training are (a) what information to relay and (b) how much. The first can be trained with descriptive or directive tasks in which a child is the speaker. A listener tries to guess or draw the described object or to follow the directions. The facilitator can use barrier games, in which he or she places an opaque barrier between the speaker and the listener, for teaching speakers to be aware of their listeners’ needs (Wallach, 1980). Some clinical materials are available commercially (McKinley & Schwartz, 1987). Because the speaker and the listener do not share the same nonlinguistic context, the bulk of the information must be carried by the linguistic element in an unambiguous manner if the listener is to comprehend. The list of fun activities in which a child directs an adult in how to do something is endless.

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When the child is the listener, the SLP can send ambiguous or incomplete messages or directions to give the child an opportunity to identify the missing semantic elements. Obstacle courses are a good vehicle through which the child can be directed or direct others. Training the correct amount of information to transmit may be more difficult. Of course, giving insufficient information in the tasks previously mentioned would make the directions difficult to follow. The SLP can train children to give more, as well as more accurate, information. For a child who gives too much information, these tasks may be trained initially one descriptor or one step at a time. These tasks then can be grouped into multidescriptor or command steps so that the child experiences offering more information. The relating of very discrete or limited events, such as combing your hair or washing your face, also can control the amount of information to be relayed. The SLP can help the child monitor his or her own production to know when redundancy occurs. The SLP can gently remind the child that certain information was relayed previously. In subsequent training, the SLP can quiz the child about the novelty or the lack of information presented. This will help the child identify the correct amount of information. Referential Skills Referential skills include identifying novel content and describing this content for a listener. Children with LLD have been trained successfully to use referential skills through the use of barrier games (Bunce, 1989). The description of physical attributes (“It’s big and white and furry.”) is somewhat easier to teach than are relational terms, such as location (“He’s in front of the computer.”). Guessing games can be lots of fun and very instructive. It may be best to pair a child with LLD with another child, rather than with an adult, because the child with LLD may assume that the adult partner intuitively knows the object or is pretending not to know. Thus, the child may provide less information to an adult partner. Topic Topic performance is an important intervention target for the following reasons (Bedrosian & Willis, 1987): 1. Its use is one means of coordinating conversations and actions, thereby fostering development of interpersonal relations. 2. It regulates the sequence of a conversation. 3. It involves the initiation of conversation. 4. It requires listening and comprehension to maintain the flow of conversation. 5. It provides a framework for making relevant contributions. In short, topic offers an encompassing framework for considering other language skills. Unlike greetings, which vary only slightly across situations, topics and methods of topic introduction and identification are context-dependent (Lord, 1988). Topic identification is a complex process that develops gradually through school age and adolescence. A successful strategy is usually to engage in whatever everyone else in the conversation is doing. Topic Initiation Initiation is the verbal introduction of a topic not currently being discussed. Children often do not understand the purpose of conversations or are reluctant to introduce topics for discus-


Part 3 Intervention

sion. Topic initiation implies an active conversational strategy. A child with LI may not be adept at introducing topics clearly or may have very limited topics to discuss (Dollaghan & Miller, 1986). Children with ASD or TBI may introduce unusual or inappropriate topics (Rumsey et al., 1985). Adolescents with moderate-to-severe ID have been taught to initiate a topic through the use of facilitator waiting and through training in the purpose of conversation (Downing, 1987). In the first step of training, a facilitator maintains eye contact for 10 seconds but does not speak. Planned delay can be an effective strategy for prompting clients to initiate conversation. If the child does not initiate the conversation during this wait, the facilitator can explain the purpose of conversation and the enjoyment that can result (Downing, 1987). He or she also can describe the roles of speaker and listener. Then the facilitator returns to the waiting strategy. If the child still does not respond, the facilitator can suggest that the child find something of interest to discuss by looking through a magazine or pictures from the child’s life. The facilitator then returns to the waiting strategy. If the child fails to initiate again, the facilitator can model a topic initiation. Some children fail to initiate conversations and topics because of a history of failure. It is important that the facilitator focus fully on the child when he or she initiates and follow the child’s lead. The facilitator should try not to interrupt the child. The facilitator might first teach the child to gain a listener’s attention. When the child inadequately introduces a topic, the facilitator can request further information to identify the topic. Focused activities, such as describing pictures or a shared event or following directions, will show the child the need to share the referent with the listener. The facilitator initially can tolerate inappropriate topics to give the child some success. Gradually, the facilitator can discuss the inappropriateness of these topics and gently steer the conversation to more appropriate ground. He or she can suggest topics (“Maybe you’ll tell me about . . . ”) and leave it for the child to initiate. The facilitator also can train the child to ask other people about their likes and dislikes, favorite foods, sports, TV shows, or exciting trips or vacations in order to include otheroriented topics in the child’s repertoire. Traditional therapy often centers on the immediate context and may inhibit generalization by failing to incorporate nonimmediate contexts. In part, the discussion of the immediate context is related to the stimulus items used with children. To increase the frequency of memory-related topics, the facilitator can encourage the child to talk about feelings or activities engaged in prior to the conversation (Bedrosian & Willis, 1987). Elicitation can be direct (“What did you do yesterday?”) or indirect (“I wonder what you did yesterday”). The facilitator can encourage the child to ask the same information of the language facilitator. In addition, she can engage the child in activities and then ask the child to discuss what was done. The SLP can provide feedback in the form of expansions of the child’s utterances. Future-related topic initiations are similar, such as discussing what the child will do next. The use of such conversationally based strategies can increase nonimmediate topic initiations, as well as the general level of syntactic performance (Bedrosian & Willis, 1987). Topic Maintenance An SLP can continue the conversation by commenting on the topic a child initiated and by cuing the child to respond (Downing, 1987). The SLP can use turnabouts—usually a comment followed by a cue for the child to respond, such as a question—to keep the conversation flowing and on-topic. Questions should make pragmatic sense; that is, the facilitator should not know the answer prior to asking. Table 11.3 is a list of various turnabouts. Off-topic responding may indicate that a child is inattentive or cannot identify the referent or topic presented. Children who are inattentive may be distracted easily and need help determining how

Chapter 11

TABLE 11.3

Specific Intervention Techniques


Variety of Turnabouts




Child: Baby’s panties. Mother: It’s the baby’s diaper, isn’t it?

Clarification (contingent query)

Huh? What?

Specific request

What’s that?


Horse? Is that a hippopotamus? (Hand object to partner and give quizzical glance)

Expansions Suggestions Corrections Behavior comment

I want one. No, it’s a zebra! (Expectant tone) You can’t sit on that.

Expansive question for sustaining conversation

What would the police officer do then?

Source: Adapted from Kaye & Charney (1981).

to focus their attention. Children with ASD may make off-topic comments because of an assumed lack of background information and experience or a lack of realization that such background is known (Lord & Magill, 1988; Rutter, 1985). A facilitator can help a child who cannot sort through the information to identify the referent or topic through the use of questions and prompts that highlight those semantic cues of importance to the child (T. Williams, 1989). Practice conversations with various partners and topics can provide an opportunity to learn and generalize. The facilitator can keep the child on-topic with such cues as “Anything else you can tell me about (topic)?” and, “Tell me more about (topic).” When a facilitator and a child have shared the same experience, the facilitator can act as a guide to keep the child on-topic. The facilitator also can help the child sequence events through the use of questions (“Then what happened?”) or probes (“Are you sure that happened next?”). The facilitator should avoid dead-end conversational bids. Dead-end bids result in a short response that ends the interaction. A common dead-end bid is the overused “What did you do today?” to which every child knows the answer: “Nothing.” Facilitators can be more specific in their topic bids. Duration of Topic A facilitator may help an incessant talker by using very limited topics with definite boundaries, such as “What animals did you see at the zoo?” If the child strays beyond the topic, the facilitator should interrupt. He or she then can remind the child of the topic and gently bring him or her back to it. The facilitator also should alert the child when he or she has provided enough information or is redundant. Such phrases as “You’ve already told me about X” or “I’ll only answer that question one more time” help the child establish boundaries. Children who provide too little information can be encouraged to provide more with “Tell me more.” An SLP also can play dumb with such utterances as “Well, I guess it was pretty boring if that’s


Part 3 Intervention

all that happened.” In general, children remain on-topic longer when they are enacting scenarios, describing, or problem solving (Schober-Peterson & Johnson, 1989). Turn Taking It is important not to initiate turn-taking training while also attempting to train topic maintenance. Too many new training targets may confuse the child. A facilitator may have to tolerate off-topic comments initially to correct inappropriate turn taking. Turn taking can begin at a nonverbal, physical level. A facilitator and a child can pass items back and forth as they use them. The item then can become the symbol for talking you talk when you hold the object. Many structured games also require turn taking. The facilitator also can provide a turntaking model by imitating the child’s spontaneous speech or using verbal games and motion songs with groups of children. Later, the facilitator can use turnabouts or a question-answer technique to help a child take verbal turns. Nonlinguistic cues, such as eye contact and nodding, can signal the child to take a turn. The facilitator can decrease questioning gradually in favor of these nonlinguistic cues and wait for the child to take a turn. Children can be taught attention-getting devices, such as increased speaking volume, to gain a turn. Games in which the child directs other people are highly motivating. Turn taking is appropriate if it does not interrupt others. A child who is overly assertive and who continually interrupts may need to be reminded not to do so. The SLP might focus instruction on identifying when speakers have completed their turns. He or she also should explain appropriate interruptions, as in emergencies. Structured exchanges through use of an intercom or mock police radio may help children understand the importance of turn allocation through play. Structured games, such as Twenty Questions, also foster turn-allocation learning. In fact, there are many games that require turn-taking skills. Conversational Repair Through monitoring, each conversational partner detects and reacts to conversational breakdowns by other people when she or he is speaking and by oneself when a partner is speaking (Markman, 1981). Children with LI often seem unaware of the distinction between understanding and failure to understand and rarely act when they do not. An SLP may modify comprehension monitoring through the use of audiotaped language samples in the following training sequence (Dollaghan & Kaston, 1986): 1. 2. 3. 4.

Identification, labeling, and demonstration of active listening. Detection of and reaction to inadequate signals. Detection of and reaction to inadequate content. Identification of and reaction to comprehension breakdown.

Although this sequence can be trained easily in an audio-recorded mode with first graders, generalization to actual conversational use should not be neglected. The introduction of puppets, dolls, or roleplaying at each step can facilitate this generalization. Written scripts may be used with older children, targeting frequent conversational contexts. Comprehension monitoring can be facilitated when a child takes an active role in the process. The child is taught first to identify, label, and demonstrate active orientation to listening behaviors, such as sitting, looking at the speaker, and thinking about what the speaker says (Dollaghan & Kaston, 1986). After learning to distinguish successful and unsuccessful performance of the three active listening

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behaviors, the child labels and demonstrates each. The child also might repeat the previous speaker’s utterance or reply to such questions as “What did (name) just say?” This can be worked into many play situations, such as playing store or restaurant. Next, the child is taught to detect and react to signal inadequacies, such as insufficient loudness, excessive rate, or competing noise. These concrete obstructions that prevent representation of the message are relatively easy to identify and enable a child to learn the difference between understanding and not understanding (Dollaghan & Kaston, 1986). Within everyday activities, the facilitator can encourage clarification requests from the child by mumbling or talking too fast. This technique works especially well when giving directions needed to complete some fun task. The facilitator occasionally can ask the child, “What did I say? How can we find out?” Once able to identify signal inadequacies, a child can be taught a variety of responses for requesting clarification. Requests may include general appeals, such as “Pardon?” (or “What?”), “I can’t hear you,” and “Wait . . . Now say it again” (or “Again please”), or more specific requests, such as, “Talk louder please” (or “Louder”), “Could you talk more slowly?” (or “Slow down”), and “Did you say X?” It is best to begin with more general requests and then move to more specific ones. The request form should reflect the child’s overall syntactic level. Next, a child can be taught to detect and react to content inadequacies, such as inexplicit, ambiguous, and physically impossible commands. For example, because inadequate content may not always be obvious, the SLP can ask the child to repeat the message to himself or herself and/or to the speaker and to attempt the task demanded (Dollaghan & Kaston, 1986). Again, the child is taught various methods for requesting clarification of inadequate content. Requests may include “What do you mean?” “Which one?”, “Where?”, “I can’t do that” (or “I can’t”), “Do you mean X?”, and “That doesn’t make sense.” This part of the training can be great fun, with the facilitator making outrageous statements and ridiculous demands of the child as in a game of “Simon says.” I still remember the expression on the face of a child with Down syndrome whom I had asked to get into his lunch box. The SLP can insert intentional content inadequacies into any number of daily activities. Finally, the facilitator can teach the child to identify and react to messages that exceed his or her comprehension capacity by the presence of unfamiliar words, excessive length, and excessive syntactic complexity. This level of comprehension breakdown may be the most difficult to detect. A child can practice identification and reaction in the form of clarification requests in real-life situations in which these difficulties are likely to occur. Most novel activities include unusual jargon that the facilitator can use to confuse the message. For example, cooking offers such words as ladle, simmer, and skillet. Requests for clarification might include “Say those one at a time” (or “One at a time”), “That was too long for me,”“I don’t know that word” (or “I don’t know”),“Can you tell me a different way?”, “What does X mean?” (or “What do you mean?”), and “Can you show me?” (or “Show me”). As training progresses, the child should learn to identify the point of actual breakdown for the speaker. The child can be aided in identifying where the breakdown occurred through questions from the SLP. NAR RATION Language intervention with narratives may focus on the organization of, cohesion within, or comprehension of the narrative. The length and complexity of narratives is positively related to the amount


Part 3 Intervention

of exposure to narratives in intervention (Gummersall & Strong, 1999). Modeling and practice are especially important. Specific targets will vary with the maturity of the child. Whether the training target is comprehension or narrative retelling, cohesion, or grammatical structure, it is important to control for the many variables that can affect a child’s performance. These may include but are not limited to the following (Boudreau & Larsen, 2004): of characters • Number line clarity • Plot of episodes • Number and complexity of utterances • Number resolution • Clear appropriateness • Age • Interest level It is also important to manage the external prompts needed by a child, such as the use of sequential pictures and verbal prompts, which can range from those needed to craft the narrative, such as “In the beginning . . . ” and “How did the story end?” to more open-ended prompts, such as “What happended next?” Narrative Structure Young children use a script-based knowledge organization system. Although older children and adults retain this system, they also use taxonomic or categoric knowledge for processing (Mistry & Lange, 1985). Scripts are sequences of events that form unified wholes. When this event sequence is placed in linguistic form, it is called a text, the basis of narratives. You’ll recall that narratives generally are organized by a story grammar consisting of a setting statement and one or more episodes that include an initiating event, a reaction by the main characters to the event, a plan, an attempt to respond to the event, a consequence or outcome to the event, and a reaction or an ending (J. Johnston, 1982; Stein & Glenn, 1979). Knowledge of episode structure forms a framework within which the child can interpret complex events and unfamiliar content. An SLP can facilitate development of internalized narrative schemes or story grammars through the following (Hewitt, 1992; N. Nelson, 1986b): 1. Involve children in organized activities, such as daily routines, to help them organize their own real-life scripts. Go over each event in a routine with children. 2. Use scripted play in which children enact everyday activities that gradually become more variable and less bound to the immediate context. 3. Read and tell real-life stories with clear scripts. The narratives can be based on the child’s experience. 4. Help children transfer from event-based to linguistic organization by telling them narratives with clearly structured story grammars and then having them dramatize the stories. These exercises may be performed orally with young children or in writing with older. Scripted play is especially useful with preschool and early school-age children and will be discussed in detail in Chapter 12. Initially, it is very important that the scripts describe familiar motivat-

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Specific Intervention Techniques


ing events, such as going to the market or getting ready for school. The script should be introduced and discussed prior to play, with expectations stated. Today, we’re going to play “shopping at the market.” How many of you have gone shopping with someone? Good. Whom did you go with, Tiera? Okay, and whom did you go with, Andre? Good. What do we buy at the market? Uh-huh. Yes. Good. I have some things right here. What’s this, Jewell? Good. What’s this, T. J.? Right. Do we buy this at the market? That’s right, we don’t buy this at the market. What’s this, Rochelle? Good. Do we buy this at the market? Good, that’s right, we do. What is the first thing that happens when you get to the market? (And so on.) The script is played and discussed afterward. With each replaying, the children change roles, modify the events, and use fewer concrete objects. As children become more adept at recounting the script, the SLP encourages telling of the narrative without an enactment. Again, familiar roles and situations are used. These procedures work especially well with groups of children and will be discussed in more detail in the following chapter on classroom intervention. The SLP can facilitate production of event descriptions by having children describe familiar events as they occur or as recalled from slides, pictures, or videotapes (Duchan, 1986b; Lewis, Duchan, & Lubinski, 1985). Children can role-play and describe familiar events as they occur. One of my favorite language lessons included mime and the acting out of familiar situations. Later, these events were described without role-playing. Pictures of familiar events from a child drawings can be used for sequencing. A facilitator can help the child identify the setting and characters by asking him or her to describe the picture; for example: Facilitator: Well, what do we have here? Child: This is me in the kitchen, and I’m making breakfast. Facilitator: So, we might say, “This morning, I was in the kitchen making breakfast.” What did you do first? (or Then what happened? or What’s this next picture?) After completing a step-by-step description, the child can be encouraged to tell the entire narrative. Episode knowledge can be taught through the use of children’s books. Book selection should be based on the following criteria (Naremore, 2001): event scripts • Familiar Pictures that support the episodes • Clearly sequenced • Appropriate lengthepisodes and language level • Stories “pretested” for retelling by the SLP • The actual story is not of prime interest. The SLP should select stories that contain all episodic elements. Intervention can begin with a mediated approach by discussing with the child the importance of stories for communication. After reading a book together, the SLP can help the child analyze the story following a “problemsolution-result” format. Learning structure is the goal. Terminology is not. The SLP helps the child break


Part 3 Intervention

the story into pieces, identify the parts, and recombine them again into a cohesive narrative. For children who can’t relate to books, the SLP can construct one-episode narratives of experiences familiar to the child. Pictures and real objects may aid the child’s participation. Narratives can be retold repeatedly, although retelling is not the overall goal. Ideally, the child will internalized knowledge to use composing and comprehending conversational and book-based narratives (Naremore, 2001). Both narrative length and structure can be improved if children have a model on which to base their narrative and a structure inherent in the model, such as story retelling using pictures (Tönsing & Tesner, 1999). Retelling can begin with short stories of a few minutes’ length. If the story is longer, the SLP may choose only a segment for retelling. Generalization can be enhanced if the narrative is related to classroom content or to events in the child’s life. Pictures can be used to depict elements of the story grammar. With older children, an SLP can explicitly teach the elements of story grammar and use graphic story organizers to help children produce complete episodes. Stories retold many times can be retold by modifying one element that will change the outcome. Commercially available resources include The Magic of Stories (Strong & North, 1996), Narrative Tool Box (Hutson-Nechkash, 2001), and Storybuilding: A Guide to Structuring Oral Narratives (Hutson-Nechkash, 1990). Narrative telling can be extended in both speech and in writing. If a child is able to retell a story with two or three complete episodes, she or he is probably ready to begin composing original narratives (Naremore, 2001). This can be accomplished within a story context with the SLP supplying the supporting structure initially. The SLP begins a story and the child furnishes the final story grammar element. Gradually, the SLP supplies fewer episode portions. In each narrative, the child completes the story by supplying the final elements until he or she can compose an entire narrative. The teaching of longer written narratives will be discussed in Chapter 13. Children then can progress to factional narratives or their own original stories. The facilitator can use questions to move children to more sophisticated ways of organizing and expressing concepts and relationships. Chapter 12 includes a discussion of replica play and narratives in the classroom. Narrative discourse is the next logical step. Children should have the opportunity to practice forms of narration within a variety of role-playing situations (Heath, 1986). Narratives can be cued by statements such as, “Tell me what you did at . . . ” or “Tell me how you did . . . ”. Cohesion It is best to teach story grammar structure prior to cohesion (Liles, 1990). Although the two are related, it is possible for a narrative to have a good story grammar and poor cohesion. Contextualized training can provide the structure needed to foster the development of cohesion. Cohesion requires some metalinguistic skill because the narrator must pay attention to the text apart from the sequence of events being presented. Cohesion is of five types: conjunctive, referential, substitutive, elliptical, and lexical. (Lexical cohesion, using terms such as yesterday, in the future, prior to, and ate/will eat, is difficult to measure reliably and is very individualized. It will not be discussed here.) Conjunctive reference is the easiest form of cohesion to teach. Children’s oral narratives can be collected and transcribed into a “book.” Use of conjunctions and the relationships expressed can be analyzed. Simple stories containing various clausal relationships also can be read to children. In a retelling, a child usually will not express relationships and conjunctions that he or she does not use. Once a child’s narrative relationships and conjunctions have been analyzed, the SLP can begin to introduce other conjunctions. A developmental order of introduction may be helpful, although the first

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priority should be conjunctions omitted or used incorrectly in the relationships expressed. For example, in “ . . . stoled all his money. He robbed a bank. He was starving . . . ,” cause and effect are suggested but without the use of because. The SLP can introduce narrative relationships with or without a conjunction and then, using a question-answer technique, prompt a child to produce the desired conjunction. If the child responds incorrectly, the SLP can reread or retell the relevant portion of the narrative, model a response including the conjunction, discuss the meaning, and prompt the child to respond again. The important aspect of the training is an understanding of the relationship expressed, not a regurgitation of the correct conjunction. The final stages of training would include original narratives produced by the child. Referential cohesion uses nouns, pronouns, and articles to designate old and new information in the narrative. Questions and answers can be used to direct the child as a narrative is told. Retellings by the SLP might use a fill-in-the-blank technique, in which the child provides the appropriate word. Gradually, less narrative-structured and more expository materials can be introduced. It is more difficult to comprehend and produce cohesion without the narrative frame. Comprehension Narrative comprehension can be improved by beginning with predictable narratives concerning everyday events or routines familiar to a child. The child’s internalized event script aids both comprehension and recall. As in scripted play, variations in the narrative are introduced gradually, and the text moves to more unfamiliar and fictionalized events and stories. Comprehension and recall can be facilitated by having children draw or write common event sequences. Before beginning a narrative, an SLP should review it with the child. Help the child bring his or her knowledge to the task. This prenarration task is discussed in detail in Chapter 12. Data suggest that the use of subjectivity or the character’s thoughts and feelings can enhance comprehension of fictional narratives (Hewitt, 1992). Children can be taught to focus on a character’s reactions as a way of making sense of the events in the narrative. Thus, the child focuses more on the reasons for and outcomes or results of events within the narrative. There are no right or wrong answers; rather, the child’s responses explain events in a manner comprehensible to the child.

Semantics Semantic intervention consists of several different but related levels of intervention. Word meanings form relationships with other words that help categorize and organize not only the language system but also cognitive processes, particularly for older children. For this reason, semantic intervention involves a variety of interrelated intervention strategies much more complex than simply training vocabulary words. At its core, word meaning consists of concepts or knowledge of the world. Words do not name things, but rather refer to these concepts. These conceptual complexes are formed from many experiences with the actual referents or with conversational or literary use of the words. The process of forming and organizing concepts may reflect general cognitive organization and, in turn, influence that organization (N. Nelson, 1986b). Semantic training must recognize the importance of these underlying concepts and include cognitive aspects of concept formation. Several commercial resources are available for training cognitive skills essential for conceptualization (Cimorell, 1983).


Part 3 Intervention

I NADEQUATE VOCAB U LARY Reference, or meaning, is the relationship of a sign or word to the underlying concept. Different strategies are used by different children and by the same child at different developmental times to construct meanings. Children with LI often use one strategy exclusively or predominantly. For example, the meanings expressed by some children with ASD seem to be unanalyzed, situationally related “chunks.” Children with ID are often deficient in their ability to form complex concepts. Other children may have conventional concepts but experience difficulty relating these underlying concepts to linguistic symbols or words. An SLP may assist with the building and extending of individual reference systems by providing situations in which children encounter the physical and social world. Dynamic events seem to encourage early concept development better than do static ones (N. Nelson, 1986b). Therefore, feature learning can be enhanced by focus on movement, contrast, and change. The most successful strategy is to (a) build on an experiential or prior knowledge base and establish links to new words, (b) teach in meaningful contexts, and (c) provide multiple exposures (Nagy & Herman, 1987). The experiential base is important, especially for the child below age 7. The child should have the opportunity to have meaningful, real experiences. For example, play in the snow could be by a lesson finding on the words used in the activity. As mentioned previously, repeated input and practice retrieval are beneficial for vocabulary teaching with children, especially those with Down syndrome (Chapman et al., 2006). World knowledge, or what the child knows about her or his world, is very important for vocabulary growth. Early word meanings are acquired within event-related experiences, especially predictable, everyday routines and their accompanying scripts (N. Nelson, 1986b). Gradually, meanings generalize and decontextualize. Between ages 5 and 9, the child developing typically reorganizes her or his vocabulary from event-based processing to more linguistic, semantic-based processing. Groups of children on a field trip can experience the world by touching, smelling, and even tasting an old log and describing the sensation. Language facilitators can encode features of events and entities to which children attend (N. Nelson, 1986b). Older elementary school children can learn from the experiences of others, much as adults do. Exposure to storybook reading has been shown to be an effective way for kindergarten children to learn new words, especially those children with poor vocabularies (Justice, Meier, & Walpole, 2005). To be effective, reading should be paired with other word-teaching strategies, such as explaining an unfamiliar word when it occurs in the story, offering synonyms, acting out the word, and pointing to the referent. Vocabulary is acquired in a two-phase process. First, words are fast-mapped—a small portion of the meaning is acquired on the first exposure. A child’s world and word knowledge affect which features of the definition she or he acquires. The second phase is a later, more gradual one in which repeated exposure results in a more complete map of the word’s meaning. Children and adolescents with LI need to learn how to use the context to establish word meaning (McKeown & Curtis, 1987; Nippold, 1991; Sternberg, 1987). Contexts provide a number of cues that can be classified as temporal (time), spatial (location), value (relative worth), stative descriptive (physical description), functional descriptive (use), causal (cause and effect), class membership (type), and equivalence (similarity/difference). Class membership and functional descriptive are the easiest for children, whereas stative descriptive seems to be the most difficult (Sternberg, 1987). Context should be established for the child prior to introducing the word numerous times. A child will need help in determining what he or she knows from the context and repeated exposures in a vari-

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ety of play or interactive contexts. Novel word learning is enhanced when words receive emphatic stress while being presented within stimulus sentences (Ellis Weismer & Hesketh, 1998). Stress is important given the difficulty children with SLI have in using syntax to acquire vocabulary (Rice, Cleave, & Oetting, 2000). In this format, meaning, use, and word class (i.e., noun and agent) membership coalesce. Narratives also may provide a context for introducing a novel word (Crais, 1987). In vocabulary training with children with SLI, a mand-elicited imitation (MEI) model is reportedly a better teaching method than focused stimulation alone (Kouri, 2005). In the MEI method, nonverbal cues, such as the presence of toys, and verbal cues, such as “What do you want?” are used to elicit requests from children. If a child does not request an item by name, the SLP can give an imitative prompt. For children with SLI, different teaching cues seem to affect learning in differing ways (Gray, 2005). For example, semantic cues (It’s made of wood) foster comprehension, while phonological cues (It begins with /s/) aid expression. Because children with poor vocabularies can have difficulty with both the phonological and semantic aspects of words, intervention with both should be explored (Nash & Donaldson, 2005). Overlearning of new words in both expressive and receptive mode seems warranted, especially for children with SLI (Gray, 2003). Several factors may influence new word learning. For example, children acquire new words more readily if they consist of frequently occurring phonemes in common word locations, if the attached morphology, such as plural -s, is not modified between the learning and testing phases, and if the novel word is presented before the referent is shown (Bedore & Leonard, 2000; Storkel, 2001; Storkel & Morrisette, 2002; Tomasello & Cale Kruger, 1992). In general, access paths to words for both TD children and those with LI become strengthened with successful use. For this reason, difficulties in accessing words by children with LI may prevent them from developing strong access paths to these words. In general, expressive use and retrieval among all 7- to 12-year-olds is positively influenced by a child’s greater familiarity with the word and its neighborhood, or area of morphemes that differ by one phoneme; greater familiarity with the word’s lexical neighbors; lower neighborhood density, or lower number of lexical neighbors; and greater similarity between the word’s stress patterns and those of the language spoken (Newman & German, 2002). Four different methods of vocabulary teaching are recommended (Alderete, Frey, McDaniel, Romero, Westby, et al., 2004): in interactive book reading • Engaging Direct vocabulary instruction • Teaching word-learning strategies for using morphological knowledge • Fostering word consciousness through “playing with language” • In interactive reading, children can be encouraged to immediately talk about objects, characters, and events and also to expand to more nonimmediate talk that goes beyond the text. Blank, Rose, and Berlin (1978) offer levels of abstraction that progress away from the immediate text. Immediate prompts ask children to point to, name, and describe by physical traits. Reordering their perceptual skills, children are asked the meanings of words used in the text, identifying characters and events by less perceptually based descriptions. Finally, children reason in response to questions about why events occurred or why emotions developed. After-reading activities can focus on discussion of words from the text and their meaning in context. Direct vocabulary instruction should focus on high-frequency words, especially those used in the classroom and essential for success. Words can be taught through a variety of methods and across sev-


Part 3 Intervention

eral situations, relating them to other words and building on the initial knowledge a child may possess. Within reading activities, words can be contextualized to aid learning. Multisensory approaches in which the child both listens to and produces the word will help to form a phonological representation. SLPs should provide examples from other contexts and encourage the child to do likewise. Word-learning strategies focus on morphology, teaching root words and various morphological affixes. This intervention can be combined with spelling instruction; etymology, or dividing words to discover their meaning; and sorting words by morphological affixes. Perhaps the most fun comes in fostering word consciousness, the final strategy. This involves word play, matching synonyms, riddles, art, drama, and poetry. This can be especially fun using figurative words and phrases. Children also enjoy creating words that do not exist in the dictionary or giving existing words new definitions. Such original words can be used along with real words to try to encourage children to make educated guesses about the meaning (Atkinson & Longman, 1985; Hall, 1984). Table 11.4 contains several original words. In a recent conversation, English-as-a-second-language learners used the word skinship, which they defined as the relationship between family members who touched frequently. No one likes to give verbatim definitions. Learning benefits if a child and facilitator can use the word to discuss a relevant topic in context. It is important to remember that the child may not need a full adult definition when the word is first introduced. A less full definition may suffice (Kame’enui, Dixon, & Carnine, 1987). The facilitator should not expect dictionary definitions from children below age 12. By that age, however, a child developing typically should be able to define words, draw conclusions, and make inferences. Child and adult definitions, especially categorical ones, seem to be organized around a prototype or best exemplar. Examples given to a child should be of the prototype, or best exemplar, variety, as these will enhance learning of salient features. In addition, the SLP should expose children to multiple examples of events and things in familiar contexts in order to perceive these features of events and entities. Language facilitators can act as mediators, framing, focusing, and providing salient features of experiences for the child (N. Nelson, 1986b). Within activities, children can be encouraged to describe features. Descriptors then can be used to determine similarities and differences and to label the world. Instead of naming unfamiliar entities

TABLE 11.4

Examples of Sniglets




n. The violent quake that rattles the entire house when the water faucet is turned to a certain point.


n. The act of parking your car, walking away, and then watching it roll past you.


n. Any of the hundreds of subscription cards that fall from the pages of a magazine.


n. The slow, seemingly endless strand of motor oil at the end of the can.


n. The aeronautical terminology for a football player who misses the punt and launches his shoe instead.

Source: Adapted from Hall (1984).

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such as types of leaves, children can be encouraged to stretch their existing language and give descriptive names, such as five-pointed leaf tree. Facilitators also can target words used frequently at home and school in everyday activities and events. In general, it is easier to learn words for known concepts than to learn both words and concepts (Crais, 1990). The choice of which words to teach should be based on the likely frequency of use, typical development, need within the classroom and use in textbooks, and likelihood of the child learning the word from context alone (Graves, 1987). Even slang expressions might be taught to aid socialization, especially among adolescents (D. Cooper & Anderson-Inman, 1988). Training should include words along with others that mean the same (synonyms), sound the same (homonyms), or are opposites (antonyms). This training will help the child organize language for easy storage and retrieval of information. Prefixes and suffixes are also important, as is syllabication. A child’s existing meanings can be consolidated by building on the child’s current vocabulary while correcting errors and misconceptions of meaning (Elshout-Mohr & van Daalen-Kapteijns, 1987). Understanding and training should progress from these general meanings to more specific ones. It is important for a child with LI to expand meanings beyond the often obvious best exemplars. Training also should proceed from more contextual meanings, as in “hit the ball,” to less contextual, more figurative meanings, such as “hit the roof,” and multiple meanings, such as “a hit musical.” Multiple meanings should be related to specific academic subject areas or contexts. The facilitator should help the child understand that meaning varies with context (Graves, 1987). Referents should be presented in a variety of ways to build a total concept. Varying contexts provide for maximum usage and exposure. Storytelling in which a novel word must be used is also a good strategy and uses context to facilitate use. Words stored without sufficient semantic knowledge are vulnerable to retrieval failure, leading to word-finding problems (McGregor, Newman, Reilly, & Capane, 2002). The semantic features of words can be analyzed to expand the characteristics associated with words and to aid categorization (Crais, 1990). Words can be classified according to their semantic features, as in Figure 11.1. Sorting tasks perform a similar function, and children can be encouraged to make their own associations. A root-word strategy can be used with school-age children to help them discover meanings and their modifications (Crais, 1990). Suffixes are easier to learn than prefixes and should be introduced first (see Morphology section of this chapter). Prefix training should begin with concrete, easy-todefine prefixes, such as un-, and proceed to more abstract ones. The most frequently used prefixes in American English are un-, in-, dis-, and non-. Many commercially available games can be used as is or modified for vocabulary training, including Boggle, Pictionary, and Scrabble (Beck, McKeown, & Omanson, 1987; Graves, 1987). Semantic organizers, such as spidergrams, can be used to build associations. Children can use semantic organizers to “brainstorm” or to tell all they know about a word (C. Nelson, 1991). Figure 11.2 is a typical spidergram. SE MANTIC CATEG OR I ES AN D R E LATIONAL WOR DS Meanings extend beyond the word level. As children develop beyond single-word utterances, they are able to encode meaning in the form of the utterances produced. Words fulfill different semantic roles, such as agent and action, that specify the relationships among those referents. Thus, a child forming a sentence must keep in mind both the referent and the semantic role.

Part 3 Intervention


Motorcycle Bicycle Car Bus Train






On Farm





Wild or Zoo Animal

Gives Milk





Runs on Rails




Chicken Duck Cow Elephant Goat




Analyzing somantic feature similarities.

Words and phrases also modify the meaning of basic sentence elements by indicating qualities, such as perceptual attributes (big, old), manner (quickly), temporal aspects (first, later), and relationships between larger sentential units, such as additive (and) or causal (because). As a listener, the child can only comprehend other people to the extent that she or he understands the various relationships underlying their utterances.

ech spe ke s





ili fm


hite House y





Lives in W


In W ashin


Speaks on television

PRESIDENT ties ents





Meets o ther presi d



f co





Ele Hea

sl aw s

s trea




Spidergram of word meanings and associations.

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Semantic Classes An SLP can teach words to children while placing the words in different semantic classes. A portion of word definition is the semantic class into which a word can be placed. The SLP also can teach other word types that relate to that class. Children with LI may find it difficult to use certain semantic classes of words. The agent function usually found in the subject position of a sentence offers a unique example for semantic category training (Connell, 1986b). English is a subject-prominent language in which a large number of elements are associated with the subject of the sentence. These elements include subjectverb agreement, as with variations of the verb to be (am, is, are) and the third-person singular, present tense -s ending; pronouns; and auxiliary verb-subject inversions in questions. These elements, while important syntactically, are not critical to the content of a sentence, and they can be omitted without greatly affecting the understanding of the sentence. For example, “Mommy eat soup?” gets the general meaning across. An SLP may facilitate teaching these elements by teaching the concept of subjecthood (Connell, 1986b). The SLP can accomplish this by using a functional approach in which he or she teaches the child the purpose of a subject. The function of a sentence’s subject, represented by a noun or a noun phrase, is to designate the perspective used in the sentence. In contrast, the topic designates the focus of the conversation. If the sentence contains action, the agent designates the actor. In the sentence “John ate the cheeseburger,” all three elements are the same. In the passive sentence “John was arrested by the police,” John is the topic and the subject, but police is the agent. Subjects can be identified by the pronouns used with them. Subjects take nominative case pronouns (I, you, he, she, it, we, you, they), whereas topics and agents may take different types. Subjects also agree with predicates or verbs (he walks, we walk), whereas topics and agents need not. The SLP can train children to identify the topic and the subject by using the following forms (Connell, 1986b): 1. Nominative case pronoun (He 2. Objective case pronoun (Him,



be is

nominative case pronoun he



verb/adjective/adverb/noun running) be is


verb/adjective/ adverb/noun running)

The first is taught in response to a “Which one is . . . ?” type of question, and the second in response to a “What is the man doing?” or “Who is . . . ?” type of question. Children can deduce the function of the subject and its separateness from the topic by the varying contexts in which they are used. Children can learn each sentence form by imitation and then in response to questions within ongoing activities. Training should begin with the first sentence type because it is included within the second. Once children have learned the formats, the questions can be alternated. Later, the habitual or simple present form of the verb, such as eat or drink, can be introduced to teach children subject-verb agreement within the same subject-highlighted format. Other semantic classes may be taught in a similar manner. Table 11.5 presents suggestions for training. Question cues can help children identity the semantic class of different words within a variety of activities.


Part 3 Intervention

TABLE 11.5

Suggestions for Training Semantic Classes

Instrument Initially, this class can be trained in the final position of the sentence, preceded by the word by, as in “The wood was split by his axe.” Position and the preposition by act as signals for this class. This class can also be signaled by the verb use, as in “John used the rake to gather the leaves.” This sentence type can be prompted by questions such as “How did. . . ?” and “What did John use to. . . ?” Patient/Object This class may be taught initially by using the final position in the sentence as a direct object to transitive verbs. Question prompts such as “What did Carol throw?” may be used to elicit this class. It is somewhat more difficult to teach this class in the subject position because that position is usually occupied by an agent. If agents are taught in response to a who type of question, patients might use what, as in “What grew in the park?” Dative The dative class is most frequently and obviously used as an indirect object. This function can be clearly signaled initially by use of the prepositions to and for. Question prompts can include these cues and the word whom, as in “For whom did Mary buy the flowers?” Temporal, Locative, and Manner These classes are relatively easy to teach because each has specific questions that prompt usage. Prepositions, such as in, on, and at, are used with these functions, as are to, with, and by, which are used to mark other semantic class use. Accompaniment The final position in the sentence and the preposition with should be used in training to signal this class. A with whom question prompt can be used to elicit response.

Relational Words Relational words fulfill many functions in language. Relationships may be based on quantity or quality and may be general or specific. Other relational words are used to mark location and time. Conjunctions are relational words that relate one clause to another. Each type of relational word requires specific intervention considerations. In general, relational terms can be acquired through descriptive tasks, in which a child must differentiate between one entity and another, or through narrative tasks, in which a child must aid the listener to differentiate characters. An SLP can help the child initially by keeping the task context-bound and by controlling the number of items or characters. By playing dumb or acting confused, the facilitator can help the child provide additional or essential information. Narratives are also effective vehicles for acquiring conjunctions, especially when the facilitator synthesizes larger, more conceptually complex sentences based on those of the child. Quantitative Terms A child does not need to be able to count to learn quantitative terms. Initial training can begin with the concepts of one and more than one. The second concept can be marked variously by many, much, some, and more. Such terms as these and those should be introduced with some caution because of deixis, or interpretation from the perspective of the speaker.

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The distinction between many and much is complex and should be ignored with children functioning at a preschool level. In general, many is used with regular and irregular plural nouns, such as cats, shoes, and women. In contrast, much is used with mass nouns—nouns that refer to homogeneous, nonindividual substances, such as water, sand, and sugar. It is not surprising that children have difficulty with the two terms much and many. Before going beyond the quantity words mentioned, the child must learn to count and have a concept of the relative values of different numbers. In other words, the child must know that 4 is greater than 2, not that 4 merely follows in a sequence. Later quantifiers can include words such as few and couple. These can be followed by other quantifiers, such as nearly, almost as much as, and half. Table 11.6 presents common quantitative words. The ordering of these words in the noun phrase is very important and is discussed in the syntax section of this chapter. Quantitative terms can be taught within many naturally occurring situations, using anything from counting blocks and Legos to candy and treats. Books and many fingerplays also contain counting. Narratives can contain several characters (e.g., friends, animals at the zoo, clowns) or objects (e.g., tools, food) that can be grouped in various ways throughout the story. It is also easy to create situations in which children request a number of objects. Quantitative terms also naturally occur within any place that replicates commerce, such as a fast food restaurant or market. Qualitative Terms Qualitative terms include such words as big and tall, plus bigger and tallest, which use the -er and -est morphological markers, and such phrases as as big as, not as wet as, smaller than,

TABLE 11.6

Common Quantitative and Qualitative Terms



One, two, three, four . . . Many, much, lots of Some, few, couple More, another Nearly, almost all As much/little as Plenty Half, one-fourth, two-fifths 10%, 75% Units of measure: inch, foot, mile, cup, pint, quart, gallon, centimeter, meter, kilometer, liter, ounce, pound, gram, kilogram, acre

Big, little, long, short Large, small, fat, thin Soft, hard, heavy, light Same, different, alike Old, young, pretty, ugly Blue, green, red. . . . Hot, cold, warm, chilly Wide, narrow Sweet, sour Nice, mean, funny, sad Fast, slow Smooth, rough Clean, dirty Empty, full Angry, afraid Comparative and superlative relationships: -er, -est, as x as, x-er than


Part 3 Intervention

and the like. Table 11.6 presents common qualitative terms. In general, children learn to use the comparative -er before the superlative -est, and training should follow that pattern. It is best to begin with the regular use of these two markers before introducing exceptions, such as better and best. Words can be expanded into phrases, for example, from bigger to bigger than. Children seem to acquire concepts one semantic feature at a time. A corollary to this hypothesis is that broad, nonspecific concepts (e.g., big) are learned before more specific concepts (e.g., long). In this example, big refers to overall size, whereas long refers to size only in the horizontal plane. The SLP should introduce terms and relationships in the order in which comparative terms develop. Table 11.7 includes common pairs of comparative terms and the approximate age at which most children can use them correctly. In general, conceptual word pairs are acquired asymmetrically. Children ages 3 to 7 appear to learn the positive member of conceptual pairs, the one that represents more of the dimension characterized by the pair, prior to learning the negative member (Bracken, 1988). For example, big and little are opposite poles of the dimension size. Big represents more size and is, therefore, the positive member. These data suggest that positive members should be taught first to children with LI. In addition, positive-type comparisons should be taught before negative ones. In other words, bigger than should be introduced before smaller than and not as big as. Positive comparisons seem to be easier for children to process. Many play situations and narratives include qualitative terms. It is also easy to devise conversations in which children must contrast one thing with another. By acting confused and asking “Which one?” a facilitator can elicit responses such as “The big one” or “The green fuzzy one.” Within several

TABLE 11.7

Common Comparative Word-Pairs

Positive-Negative (age)

Positive-Negative (age)

Positive-Negative (age)

same-different (36–60 months) in front of-behind (48–54 months) into-out of top-bottom (48–54 months) rising-falling healthy-sick big-little (30–48 months) deep-shallow thick-thin hard-soft (30–42 months) smooth-rough more-less (42–72 months) all-none old-new before-after (66–72 months) open-close

inside-outside over-under (42–48 months) front-back (48–52 months) above-below (66–72 months) right-wrong heavy-light (30–48 months) tall-short (30–84 months) loud-quiet sharp-dull solid-liquid full-empty (36–48 months) with-without (48–54 months) arriving-leaving first-last (60–66 months) on-off (24–36 months) up-down (36–60 months)

high-low (42–60 months) forward-backward happy-sad old-young large-small (78–84 months) long-short (horizontal) (54–60 months) hot-cold dark-light tight-loose a lot-little fast-slow early-late always-never

Note: The overall order does not reflect the order for teaching conceptual pairs. Source: Bracken (1988); Edmonston & Thane (1990); Wiig & Semel (1984).

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situations, such as play or snack, children can be offered choices based on some contrasting feature, such as size or color. Spatial and Temporal Terms Several words are used to mark both space or location and time and, thus, are potentially confusing. Among the most commonly used words in English are prepositions, such as in, on, at, and by. Each of these small, seemingly insignificant words has several definitions. In the Syntax section of this chapter I discuss prepositional training. In addition, other words, such as first and last, also note place and time. Spatial concepts are best taught first in relation to the child; then with “featured” or fronted objects, such as a television, chair, or person; and finally with nonfeatured objects, such as a wastebasket or a ball (Edmonston & Thane, 1990). The latter is more difficult to learn because it involves deixis, or interpretation based on the speaker. In general, vertical dimensions (on top) are learned before horizontal. Horizontal front and back terms, such as in front of and behind, are learned before horizontal side-to-side terms, such as beside and next to. The order of temporal term learning reflects the underlying concepts of order, simultaneity, and duration (Edmonston & Thane, 1990). Terms that denote order, such as before, after, first, and last, usually are learned before terms for simultaneity, such as at the same time, during, and when. Duration terms, such as a long time, generally are acquired last. In general, it is better to begin with concrete definitions and progress to more abstract ones. For example, with first, last, before, and after, training can begin with objects in a line or with a train. The facilitator can have the child touch individual objects, then a short sequence of objects (first, last) and finally a reverse sequence (Touch first after last.”). Sequencing objects should be used before terms for sequencing events and the concept of time sequencing. One context is not enough for teaching concepts of space and time. The greater the number of contexts, the more learning and generalization that will occur. Language can be used to help a child organize the environment by marking experiences of space and time. Table 11.8 includes common spatial and temporal terms. The SLP can use direction-following games and activities to train children about space and time. It might be best to begin with routines that the child knows, such as those that occur at home or in the

TABLE 11.8

Common Spatial and Temporal Terms Spatial

next to before after on, on top in, into in between between middle above

under over below corner bottom inside outside side end


in front of behind beside right left through high, tall upside down together

next before after in, to soon later now above yesterday

today tomorrow calendar dates months seasons numerals for years morning afternoon evening

days weeks hours minutes through away from toward sometimes


Part 3 Intervention

classroom, and then move into less familiar activities, such as using a pay telephone or changing a tire, in which the child must rely more on linguistic input. Actinities involving making or cooking are excellent. Later, the SLP can use sequenced pictures or storytelling in the training. Pictures may seem very abstract to some children, especially school-age children with ID and preschoolers, and should be used with caution. Children can identify what happened first, next, and last. Deixis and the use of deictic terms are very difficult concepts to teach. The facilitator who takes both the role of speaker and prompter for a child violates the roles in a conversation. The simple example of here and there is illustrative. The request “Put the ball here” is said from the speaker’s perspective. To the listener, the speaker’s here is most likely there. If the speaker then shifts to the listener’s (the child’s) perspective and says, “Yes, put it there,” it may confuse the child further. How can it be both here and there for the speaker? When training the child about deictic terms, it is best to sit next to the child so that you can share a perspective. From this shared perspective, deictic terms for location would be similar. Another facilitator, puppet, or prerecorded tape may act as the other conversational partner. The teaching of deixis is discussed also under the topic of pronouns in the Syntax section of this chapter. Conjunctions An SLP should teach conjunctions in the order in which they develop by noting for a child the relationships expressed in each (Klecan-Aker, 1985). For example, because represents cause and effect and may not be fully acquired until about age 12. Table 11.9 presents the general order of conjunction acquisition. The conjunction and can first be taught to combine entities, as in “cats and dogs.” In a cooking activity, the facilitator might say,“Which two types of cookies do you like best?” or, “Tell me your two favorite types of cookies.” In similar fashion, but can be used for like/dislike distinctions (“I like cookies, but not beets”). A clause + conjunction + clause format can be employed initially to help the child acquire the underlying relationship. For example, sentences might be presented as follows: We wear a coat because it is cold. We wear a coat if it is cold. We wear a coat when it is cold. Once a child understands these relationships, the order of the clauses can be reversed, as in “Because it is cold, we wear a coat.” Next, the SLP can present clauses for the child to combine. The breakdown and buildup technique, described in Chapter 10, may be used to help the child identify clauses and conjunctions and then reconstruct the sentence (Klecan-Aker, 1985). Conjoining clauses with conjunctions is a natural occurrence within narratives and can be prompted through storybook retelling or with pictures. The SLP can reply to a child’s utterance by supplying the desired conjunction and then asking for a restatement as in the following: Child: Adult: Child: Adult: Child:

And the whole bridge fell down. Why? Because . . . ’Cause the water was going so fast. That sounds very exciting. Tell me the whole thing again. The bridge fell down because the water was going fast.

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Adult: The bridge fell down because the water was going fast. That’s scary. What happened next? WOR D R ETR I EVAL AN D CATEG OR IZATION Word-finding difficulties can result from two possible sources (Kail & Leonard, 1986). The first is lack of elaboration or lack of a well-established, thorough representation of the word within the child’s internal dictionary, or lexicon. Word knowledge is related to storage ability in that growth in word knowledge results in a larger storage capacity. An increased lexicon requires greater semantic networks in which to group words. In general, children who exhibit difficulties often have less extensive vocabularies and poor word knowledge (Kail & Leonard, 1986). The second source of problems is in retrieval. In general, children with this problem are less efficient in retrieving words from storage. Whereas elaboration difficulties may occur alone, retrieval problems usually do not and may be an additional difficulty found in some children with elaborative problems (Kail & Leonard, 1986). In short, children with poorly established word meanings have a semantic storage problem. In contrast, those with word-retrieval problems on words that they understand have poor retrieval skills. Finally, some children have problems in both areas. These last children should receive intervention services that combine the goals of the other two. A number of activities have been suggested that facilitate word-finding skills (McGregor & Leonard, 1989; Wing, 1990). Children appear to benefit from both elaboration and retrieval activities (McGregor & Leonard, 1989). Word-finding activities can be incorporated easily into a number of everyday activities and conversations about these activities. Prior to beginning intervention, it is important to determine the source of the problem (German, 1992). An SLP should derive naming data from a variety of activities to be certain of the cause of the problem. In general, children name real objects and colored pictures with a higher accuracy than blackand-white pictures (Barrow, Holbert, & Rastatter, 2000). Naming words in a meaningful context is also performance enhancing. Children with storage problems have difficulty understanding and retrieving words that are not stable in their memory. Inadequate storage is the result of shallow meanings, reference-shifting problems, and poor analytical and synthesizing skills (German, 1992). The goal of intervention is to improve word knowledge and storage. Those with retrieval-only problems have difficulty with search and recovery. Somewhere in the process of discriminating the desired word from among competing words and constructing the phonological specifications for production, the process breaks down (Bjork & Bjork, 1992). The goal of intervention is to improve access. Memory storage seems to be affected by the depth or level of processing. In general, recall is best for words processed at the deepest levels, which are elaborative by nature (Lockhart & Craik, 1990). Theoretically, acoustic processing, such as rhyming, is surface processing; categorical is mid-level; and semantic/syntactic is deep. Words are remembered in relation to other words and form meaning networks. Such relationships might be morphological (Nagy et al., 1989). When one member of the family is accessed, it activates others. These relationships are based on meaning, not just linear sound or letter strings. In other words, ride might elicit drive or pedal but not elicit stride, cad might elicit villain but not cadet. Semantic similarity and, to a lesser degree, phonetic similarity do affect judgments of relatedness. Networks of semantic-related morphemes are part of each individual’s memory system. Thus, stain, stained glass, and stainless steel are perceived to be related.


Part 3 Intervention

TABLE 11.9 and and then but, or

Acquisition Order for English Conjunctions because so, if, when until, before-after

although, while, as unless therefore, however

Note: Data from studies are very variable, and this list is only a rough guide. Source: Based on Bloom, Lahey, Hood, Lifter, & Fiess (1980); L. Lee (1974); Wiig & Semel (1984).

Elaboration training focuses on organization of the child’s lexicon and generalization of word meanings to everyday use (Kail, 1984; Kail & Leonard, 1986). In children developing typically, increased word knowledge results in increased storage strength. In short, a larger vocabulary means a more extensive database. In elaboration training, an SLP can use semantic focus strategies, such as nonidentical examples and word comparison tasks. The SLP presents nonidentical examples of the word in several linguistic contexts, to enrich a child’s definition and word associations. Nonidentical examples for house might include dollhouse, housefly, and greenhouse. In comparative tasks, the SLP expects the child to identify similarities and differences between two words with related meanings, such as house and hotel. A mnemonic or “key word” strategy (Parente & Hermann, 1996) also might be used to aid elaboration and recall of new vocabulary. New words are linked with acoustically or visually similar words with which the child is familiar. For example, dogged might be linked with dog. This initial linkage is gradually modified by the child through use to a semantic one with deeper processing. Pictures and written descriptions may be used to link two words. A known word is used to aid learning and storage of an unknown one. In the above example, a dog would be portrayed being stubborn or determined (dogged). Under the picture, it might read The dog was dogged and would not give up. Other examples are given in Figure 11.3. The key word now becomes the retrieval cue. Children using this approach reportedly are able to recall 50 percent more definitions than those taught vocabulary by a more traditional method. In addition, the combined picture and sentence format appears to be more effective than either used separately (Condus, Marshall, & Miller, 1986). Children seem naturally to enjoy word games and word play, and these teaching strategies can be incorporated into many types of activities. As a communication partner, I like to get very “confused” and use words in silly ways. Children laugh and freely correct their somewhat slow-witted communication partner. Data from typically developing children suggests that taxonomic, or categorical, such as things to write with (crayon, marker, pencil), and thematic, or event, such as the act of writing (paper, pencil), relations develop differently and can affect word recall (Hashimoto, McGregor, & Graham, 2007). In addition, taxonomic relationships are originally based by children on observable perceptual features (shape, size). This data suggests that for preschool and kindergarten children thematic cues might assist word recall. Taxonomic cues should begin with obvious perceptual similarities. Retrieval training may include categorization tasks, such as naming members of a category or identifying the category when given the members. Categories include animals, clothing, grocery items, and the like. Categories also may be formed by the initial sounds of words and by rhyming. As a group, children with LI are less likely than children developing typically to discover semantic organization strategies on their own and usually require more examples to determine a basis for organization and for generalization of organizational skill. Word-retrieval errors should demonstrate

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Examples of mnemonic strategies.

the predominant organizational framework of the child and alert the SLP to the patterns that need strengthening. Categorization tasks, especially such familiar ones as Saturday morning cartoon shows, in which the child names members of the category, facilitate recall by building associational and categorical linkages between words. We usually recall a word by first accessing the category to which it belongs. Of course, the possibility still exists that a child will access the right category but retrieve the wrong member. Categorization tasks can be elaborative in nature when members of more than one category are presented together. For example, the items chair, bed, and table can be classified as furniture; chair, swing, and bicycle are things on which you sit; and bicycle, car, and bus are vehicles. The facilitator could present these items together and ask the child to classify them in as many ways as possible. Training might begin with actual objects and children making piles of objects that go together (Parente & Hermann, 1996). As a child, I sorted my comic books by main character and my baseball cards by team. Similar tasks are found in several everyday activities. Children can make collages in school of things that go together. After objects and pictures, then words can be used. Entities might be classified by description (e.g., cold) or by function (e.g., things that you ride on). The facilitator should encourage the child to use as many different sensory descriptions as possible to describe objects. Objects or toys, then pictures, and finally words can be sorted and then used to facilitate cognitive organization (Parente & Hermann, 1996). After sorting, a child can be asked to recall the categories. Once the child has recalled categories, he or she can be asked to recall members. Categories might include semantic/hierarchical groupings, perceptual similarities, and rhyming, spatial, and locational


Part 3 Intervention

groups. Everyday tasks such as preparing grocery lists, organizing chores, or planning items to take on vacation or items that go in your backpack or your room have more relevance than arbitrary groupings. For example, prior to making a computer composite picture of the inside of a house, a child could identify objects to go in each room. Verbal training should begin with common words for everyday concrete objects (Nippold, 1992). Familiar everyday objects and events should be used. This notion is sometimes difficult for adults to understand, especially if they are attempting to bring interest and variety into the training. I am reminded of a teacher who tried to teach zoo and farm animal categories but found the children very unresponsive. Both categories were outside their realm of experience. When one child suggested the category of animals seen “squashed” on the highway, every child became a participant. Although the example is somewhat gruesome, the lesson for SLPs is very practical. Everyday natural environments provide specific cues that aid memory (Nippold, 1992). Word-retrieval difficulties can be helped by (a) naming/descriptive tasks (“It’s a bicycle; you ride on it by peddling”), (b) associational activities (“Red, white, and _____”), and (c) sentential elaboration tasks based on syntactic characteristics of two words drawn at random (“The trailer was parked near the restaurant while the driver ate”) and open-ended fill-ins and completions (“We eat with a _____”) that involve deeper levels of processing (Casby, 1992). Word-sorting tasks can aid in the development of categorization and recall skills. Taxonomy charts, especially for newly introduced classroom content, also can help children develop categorization strategies. Although semantic strategies appear to work well, they are not the only ones. With some children, a combination of phonological and perceptual strategies may also be effective (Wing, 1990), although semantic elaboration and retrieval activities produce better results than phonological strategies alone (McGregor & Leonard, 1989). In phonological training, the child participates in segmentation exercises such as rhyming, initial sound matching, and counting syllables and phonemes. The rationale for this method is that, in part, breakdown is the result of poor phonological representation of the word. Phonologically based treatment that focuses on words that begin with the same phoneme and words that sound alike can reduce semantic substitutions (McGregor, 1994). The child is trained to think about the first sound in the word when attempting to retrieve the word. Perceptual training involves imagery activities, such as simultaneous picture and auditory exposure, visualization with eyes closed, and silent name repetition. This procedure progresses to matching pictures to a “memorized” sample of names. The facilitator can help a child note perceptual and functional features and attributes that determine how members are categorized. The child with LLD will have particular difficulty abstracting salient features and, therefore, will have difficulty forming categories based on these features. One mediational strategy might be to teach the child to ask a set of questions to establish an association between a new item and something familiar. Questions might include the following (Parente & Hermann, 1996, p. 50): What does it look (sound, smell, taste) like? What does it mean the same thing as? What groups does it belong to? Who is it commonly associated with? It is important that children note a similar attribute on more than one object. Otherwise, children may begin to associate certain attributes with specific items. For example, several very different objects

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may be described as wet. This kind of task naturally leads to categorization. Attributes should appear also in many different linguistic forms, rather than just “It’s . . .” in order to enhance storage and memory. Categorical identification by a facilitator seems to be the best cue for recall when a child is stuck or blocks on a word. By naming the category, the facilitator can help the child locate the desired word more easily. Partial word cues also may help the child and are less confusing than synonyms. Sentence completion and nonverbal, gestural cues are also aids. Even the most effective strategies have limitations, suggesting that some children have severe deficiencies in the size, elaboration, or organization of their lexicons (McGregor & Windsor, 1996). Speed and accuracy of retrieval are important. In general, retrieval speed and accuracy are correlated (German, 1990, 2000; Guilford & Nawojczyk, 1988; Wiegel-Crump & Dennis, 1986). In children developing typically, speed and accuracy improve with maturity. Retrieval using picture cues is easier than naming to a descriptive cue. Naming to a rhyme is the most difficult (Wiegel-Crump & Dennis, 1986). Several retrieval strategies are listed in Table 11.10. In intervention, retrieval units should move from single words to discourse. As mentioned previously, it is important to keep in mind the “What’s the point?” criterion. The relationship of responses to naming exercises and word finding in conversation is unknown. Overall, responses to pictures may be of relatively little value. At a minimum, it is essential that training include a strong conversational element to ensure generalization of word-finding skills (Dennis, 1992). It may be helpful to teach a child strategies for circumventing word blocks (German, 1992). Synonyms, category names, and multiword descriptions may enable the child to continue the conversation and to work through the word-retrieval difficulty. Compensatory programming, such as modifying classroom tasks, also may aid the child with word-retrieval difficulties (Table 11.11). It is essential that those in the child’s home and classroom modify expectations and cue the child in the most advantageous manner. COM PR E H E NSION Very young children, lacking good word definitions, use their knowledge of familiar event sequences to structure their responses (Paul, 1990). As mentioned previously, familiar events provide scripts that aid comprehension and participation. Even later, when children and adults rely on lexical and syntactic cues, it is still easier to comprehend information in familiar events and contexts. In early preschool, a child matures from reliance on the immediate context to reliance on stored experience for interpretation. This stored experience is called world knowledge. The child uses world knowledge to structure a “probable event” strategy of interpretation. Only gradually does the child gain the ability to rely more on word order. By late preschool, ages 31⁄2 to 5, word order is used more consistently for interpretation (TagerFlusberg, 1989). Linguistic knowledge becomes the preferred comprehension strategy, although no clearly dominant strategy is evident. Preschoolers still rely more readily on contextual knowledge. It is not until ages 5 or 6 that children use syntactic and lexical interpretation more consistently (Keller-Cohen, 1987). They still make errors, of course, usually by ignoring clausal boundaries and interruptions in the flow (Wallach & Miller, 1988). By ages 7 to 9, children are more sensitive to boundaries, embedding, and temporal connectives. Children with a range of LIs perform similarly on language comprehension tasks (Bishop, 1982). They exhibit poorer comprehension than their peers developing typically (D. Bernstein, 1986; Nippold, 1985; Spector, 1990). In general, there is a greater tendency among school-age children with LI to rely


Part 3 Intervention

TABLE 11.10

Word-Retrieval Strategies Retrieval Strategies

Attribute cuing

Phonemic cuing

The initial sound, vowel nucleus, digraph, or syllable is used to cue the target word.

Semantic cuing

The category name or function is used to cue the target word.

Graphemic cuing

The graphic schema is used to cue the target word.

Imagery cuing

A revisualization of the referent is used to cue the target word.

Gesture cuing

The motor schema of the target word action is used to cue the target word.

Associate cuing (story for book) Semantic alternates

An intermediate word is used to cue the target word. Synonym/category substitutions

Semantic components (synonym or category words) are substituted for the target word.

Multiword substitutions

Semantic components (functions or descriptions) are substituted for the target word.

Reflective pausing

Constructive use of pausing is used to reduce inaccurate competitive responses.

Remedial Strategies

Stabilization of phonological specifications

Rapid naming




Students practice saying or writing the target words five times alone and then in five different sentences.

Rhythm + rehearsal

Each syllable is marked with a tap during the above rehearsal of the target word.

Segmenting + rehearsal

A line is drawn between each syllable during the above rehearsal of the target word. Students rapidly say names of and phrases with target words until their response time is reduced.

Source: German, D. J. (1992). Word-finding intervention for children and adolescents. Topics in Language Disorders, 13(1), 33–50. Reprinted with permission.

solely on word-order strategy and to retain this strategy longer than do children developing typically (F. Roth & Spekman, 1989a). Preschool children with LI overuse word-order strategies earlier and use of world knowledge less than their TD peers (Lord, 1985; Paul, Fisher, & Cohen, 1988; Tager-Flusberg, 1985). As a result, the comprehension strategy is less flexible and there are fewer alternative strategies than in children devel-

Chapter 11

TABLE 11.11

Specific Intervention Techniques


Oral Questioning Modifications for Word-Retrieval Problems

Word-Finding Profile

Content Areas

Difficulty retrieving specific All words: inaccurate namer

Classroom Activity

Oral questioning

Recommended Modifications for Teacher

1. Use multiple-choice frames 2. Accept volunteer participation only 3. Provide target word cues (e.g., initial sound, syllable)

New Materials

Advance organizer

4. Use questions that require yes/no or true/false response Difficulty retrieving specific All words: slow namer

Oral questioning

1. Prime student for questioning 2. Give student additional time to answer

List of possible questions

3. Use multiple-choice frames 4. Use questions that require yes/no or true/false response Source: German, D. J. (1992). Word-finding intervention for children and adolescents. Topics in Language Disorders, 13 (1), 33–50. Reprinted with permission.

oping typically (Paul, 1989a, 1989b). It is not surprising that higher interpretative skills, such as those used to comprehend humor, are often not observed in children with severe LI. Even mature language users rely on world knowledge to some extent (Milosky, 1990). Comprehension consists of both decoding the syntactic and semantic information and interpreting that information based on the linguistic and nonlinguistic context and world knowledge. While comprehension intervention is a worthy goal in and of itself, I should caution that training word recognition alone does not ensure production of newly learned words (Kiernan & Gray, 1998). The goal of intervention is to teach the child to retrieve relevant word and world knowledge as a comprehension aid and to help the child decide how and what to remember from what he or she hears or reads (Trabasso & Van Den Broek, 1985). Comprehension and memory are aided by familiar, meaningful contexts; thus, intervention should occur within familiar routines and locations (Milosky, 1990). The degree and type of experience the child has with events strongly shapes his or her expectations and, thus, comprehension. Meaningful activities are more comprehensible; they make more sense. Familiar play and role-play of everyday events can enhance comprehension. The level of involvement also affects memory and comprehension (Lehnert & Vine, 1987; Miall, 1989). The more involved a child is, the more he or she comprehends and recalls. Songs, nursery rhymes,


Part 3 Intervention

and finger play can be used to help a child make active associations between words and the nonlinguistic context (Paul, 1990). The repetitive nature and limited focus of such activities help shape expectations and aid comprehension and memory. In “Where Is Thumbkin?” the structure is where . . . here with the phrases repeated several times. Similarly,“Farmer-in-the-Dell” uses an agent + action + object format in each verse (The farmer picks a wife . . . ) (Paul, 1990). These repetitions aid comprehension. Finally, comprehension intervention should be pleasurable. Fun activities keep children engaged, a necessity for comprehension and comprehension training. Involvement is fostered by facilitator feedback. A pleasing manner encourages responding and making use of the feedback (Paul, 1990). Initial comprehension training may need to be very concrete and highly contextual. Preschool children benefit more from direct labeling instruction than from less direct use of narratives (Kouri, 1994). The use of gestures and a slower rate of talking by the language facilitator also enhances comprehension by young children (Weismer & Hesketh, 1993). Likewise, slower rate improves the receptive language processing of children with SLI (Montgomery, 2005). As children approach school age, training should become more decontextualized, similar to many of the literate activities found in school. Comprehension training might begin with recall from pictures or objects and progress to literal recall of one or more details from verbal sources. Gradually, an SLP can require a child to recall more details. Later, the child can detail these in sequence, possibly using sequential pictures, photographs of past events, or comic books as aids. Daily events can provide a script to aid comprehension. Next, the SLP can require the child to relate cause and effect from familiar or recently read narratives. Once able to reconstruct these relationships, the child can begin to make inferences, to draw conclusions, and to predict outcomes from stories, riddles, and jokes. Finally, the child can learn to synthesize information and create subjective summaries of the meanings of narratives, TV shows, or movies. To assist comprehension, the SLP can shape question-response strategies by manipulating the semantic content, complexity, context, and function (Parnell & Amerman, 1983). The therapy process moves from simple, context-embedded questions to the use of questions in more abstract contexts, while controlling the length of the questions to highlight semantic content (Moeller et al., 1986). For example, in the first stage, the facilitator might attempt to build awareness and enhance emerging skills by using topics of high interest as the question contexts. The facilitator concentrates on establishing repeatable responses to yes/no questions by using a second adult as a model, multiple-choice alternatives (“Did the ball roll under the sofa? Yes or no?”), visual cues to signal that a response is desired, and the child’s natural, everyday contexts. In the second stage, early-developing wh- question forms might become the targets, and yes/no questions be used to highlight the semantic content desired. Take, for example, the question, “What is the girl wearing on her head?” A nonresponse, an inappropriate response, or an inaccurate response might be followed by “Is she wearing a shoe on her head?” If the child responds negatively, the prompt would be “That’s right, what is she wearing on her head?” Print, pictures, or signs can be used to highlight the wh- words and, thus, emphasize the information desired. These prompts can be faded gradually. In the third stage, new wh- forms are added systematically. Developmental data suggests a logical order for teaching wh- words and question types based on concept learning. Initial wh- words concern things (objects), persons (agents), possession, and locations, all early expressions in children’s utterances. These include the wh- words what, who, whose, and where respectively. Soon children learn distinctions between things, as expressed in the word which. Around age 4, they become aware of sequence, time, and causality, or the wh- words and questions how, when, and why respectively. In the final stage,

Chapter 11

Specific Intervention Techniques


stimulus content is shifted gradually from concrete, predictable, factually based academic topics to more abstract, less predictable conversational ones. School-age children might manipulate objects or pictures and match them with the sentences heard (Wallach & Miller, 1988). For example, the child might be told to place a small red ball on top of a large yellow box. Similarly, the child might select a picture described by the facilitator from among a set of pictures. Written cues also could be used. The child also might match sentences with similar meaning. Synonyms can be introduced. Metalinguistic skills can be enhanced by tasks in which the child judges similarity and difference among sentences (van Kleeck, 1984). This task may be difficult for those with poor working memory. Figurative Language Figurative language consists of idioms, metaphors, similes, and proverbs. Idioms are a form of figurative language that is particularly troublesome to comprehend for school-age children with LI and for children from CLD backgrounds (Lutzer, 1988; Seidenberg & Bernstein, 1986). The most common error is literal interpretation. Although idioms are a concise, colorful, and intriguing way to express complex meanings, they are very diverse and, thus, difficult to learn as a group. Idioms vary along several continuums, including single-words-to-clauses, colloquial-to-formal, and concrete-to-abstract. Difficulty with idioms can affect classroom comprehension because of their frequent occurrence (Nippold, 1991). Approximately 11.5 percent of teacher utterances contain at least one idiom, with a range from 4.7 percent in kindergarten to 20.3 percent in eighth grade (Lazar et al., 1989). Similarly, 6.7 percent of the sentences in textbooks contain idioms, with a range from 6 percent in third grade to 9.7 percent in eighth (Nippold, 1990). The meanings of idioms are inferred gradually from repeated exposure in context. In addition, idiom learning requires metalinguistic skills and is closely associated with familiarity with the idiom and skills in reading and listening comprehension (Nippold, Moran, & Schwarz, 2001). Children with LI may lack a strategy for determining meaning. Some common high- and low-familiarity idioms are listed in Table 11.12. Intervention should begin with comprehension of transparent or easily decipherable idioms. Narratives may be the best teaching milieu because of the contextual support (Nippold, 1991). The child can be instructed prior to the narrative that it will contain a certain idiom and that he or she will be able to figure out the meaning from the story. Questions can be used throughout the narrative to help the child attend to important information. Answers can be redirected to ensure that the child is attending to salient points. After repeated exposure and the child’s correct interpretation, he or she can be encouraged to invent his or her own narratives that illustrate use of the idiom. Finally, conversationally appropriate use can be discussed and role-played. Proverbs depend on their context to be good advice. Sometimes he who hesitates is lost, but at other times, it’s best to look before you leap. The context in which the proverb is used also facilitates understanding. In general, concrete proverbs are easier to interpret than abstract, and familiar easier than unfamiliar (Nippold & Haq, 1996). The ability to explain proverbs lags behind the ability to select an appropriate interpretation from a list of possible meanings (Nippold, 2000). Obviously, an explanation reapires more linguistic skill. The ability to interpret and use proverbs develops during late elementary school and continues into adulthood and is related to reading and metalinguistic abilities. With this in mind, an SLP is advised to teach proverb interpretation within the context of reading (Nippold, 2000). Working in


Part 3 Intervention

TABLE 11.12

Common American English Idioms


A bull in a china shop As stubborn as a mule Going to the dogs Playing possum Go into one’s shell

A fly in the ointment Clinging like a leech Grinning like a Cheshire cat Thrown to the wolves

Body Parts

On the tip of my tongue Raise eyebrows Turn the other cheek Put their heads together* Vote with one’s feet

Breathe down one’s neck* Put your best foot forward Turn heads Put one’s foot down* Lead with one’s chin


Dressed to kill Hot under the collar Wear the pants in the family

Fit like a glove Strait-laced Talk through one’s hat


Grey area Once in a blue moon Tickled pink

Has a yellow streak Red letter day True blue


Eat crow Humble pie That takes the cake

A finger in every pie In a jam Put all your eggs in one basket

Games and Sports

Ace up my sleeve Cards are stacked against me Got lost in the shuffle Keep your head above water Paddle your own canoe Rise to the bait Skate on thin ice*

Ballpark figure Get to first base Keep the ball rolling On the rebound Go around in circles* Cross swords


Heard it through the grapevine Resting on his laurels Beat around the bush* No bed of roses

Shaking like a leaf Withered on the vine Hoe one’s own row


Fix your wagon Like ships passing in the night On the wagon

Don’t rock the boat Missed the boat Take a back seat

Chapter 11

TABLE 11.12

Specific Intervention Techniques


Common American English Idioms (cont’d)

Tools, Work, and School

Bury the hatchet Has an axe to grind Hit the nail on the head Jockey for position Throw a monkey wrench into it Read between the lines*

Doctor the books Has a screw loose Hit the roof Nursing his wounds Sober as a judge


Calm before the storm Haven’t the foggiest Steal her thunder

Come rain or shine Right as rain Throw caution to the wind

*Highly familiar Source: Compiled from Clark (1990); Gibbs (1987);